Android App with Simple Form

Hello, I need an android app which will have a form of 6 fields (Form ID, Name, Date of Birth, Phone Number, Gender (dropdown), User ID (get the email account id used in play store). Once data will be saved user will be sent to the list view of the # of forms filled. Each form will have 2 options (Save, Upload to Server (mySQL)) Once the form data is uploaded the user will get a confirmation message on the screen