Simple online enrolment form

EF International Language Schools is an English Language college based in Australia. We are launching a new package product in association with a Registered Training Organisation (Sydney Higher Education Institute). We are selling the course package and processing enrolments. We need to create a simple enrolment form online, accessible via a URL. I attach the content of the Enrolment Form, as well as the high-res logos of both education providers for the creation of this single page site. There are also a couple of enrolment forms already existing online that form the backbone of ours (we sell the same course): https://tesol.sydney/apply-now/ and https://tesolau.com/enrol/ (choose Cert IV 10773 NAT in drop down).
Applicants have to upload some documents (evidence of English proficiency & photo ID). Once the applicant submits the application, an application document is generated and sent to my email address for processing.
Let me know if the script I have prepared is sufficient or if you need further information - or if you see any way we can improve this webpage.