Create a Form from a Document with Captcha

I have a 2 page document that needs to be made into a form with CAPTCHA.? I have a few extra things to add to the form as well as doing something with a electronic signature (or something at the bottom stating that if they type in their name that is giving us permission to run their credit,criminal and background check) I need the ip address to come to me if possible. I am Hosting is Linux on Godaddy.