Prepare template for Form

I need 1 responsive form to create - HTML, JS/JQ, CSS. Form is ment to insert data about day plan in a most convenient manner. Step 1: User is clicking on a button "add new day" or "remove last day" (which will not be activated since there is no days to remove) Step 2: User is able to add activities into "Day 1" similarly as step 1 - there are 2 buttons - "Add activity" and "Remove last activity" (which once again will not be activited since there is no activities yet) Step 3: User add activity. Activity is created from 3 fields, where one is complex one and have to be built from icons which will represent type of activity (icons are mine to gave, so just put some [login to view URL] into it) after choosing an icon there will be dropdown with name of activities of selected type (I will produce the data) on item selected bellow should be displayed name of the option selected, two other fields are numeric inputs which will contain both information about quantity. If there are more days then 1 inserted, there is 4th field dropdown - "Copy Activities from Day:" User can Add X days at once in one form, or just create one particular day. We talk only about HTML + JS + CSS (no icons no data)