Basic JQuery Form Mobile App

Hi, I need a form with pictures to be filled out on a native iPhone/iPad app (needs camera support), with the results then compiled to a word document template and emailed. I am happy just to tweak the existing templates, no flashy UI -just need someone to put the code in the back end to make it all work. I imagine it would go something like this: Phonegap + JQuery form submits photos and text to PHPWord, which merges it to a .docx, with the file then emailed to a preset address with parameters of the form as subject field, and copied to a folder. PM for more details.