whats the best way to create this digital waiver form?

I'm looking to use adobe, or comparable software, that would allow me to make a copy of a waiver form, and have the fields that are presently being handwritten and signed, be converted to spaces that can be entered and "signed" electronically. ultimately I would like to be able to acquire the inputted info (name/address/dob/date signed...etc) and pull it into a database that i can then use to market to the customer "from a certain month" or a certain date of birth, and do mass emails to all that apply to a certain parameter or range.  can someone please point me in the best direction?



thank you in advance