Help needed building a church sign up

Hey, I am one of the people in charge of my church website and the RCA (Reformed Churches of America) is coming to Holland. The RCA is an organization where all the reformed churches across America come and meet and discuss church issues. During this time there is a 24 hour prayer sign up where people can go online and click on a time for them to have prayer, which also includes the time, date, their name of some sort and their email. I’m not quite sure how to do this, so I was wondering if anyone here had the ability to do something like this. Here is an example of what I’m looking for.

http://www.loveasu.com/247prayer21days.html?gid=2233459901

Thanks in advanced.