Agree with JHB.
What you provided looks more like a report (data output) than a form (data input). If I were to create an input form for that data it would be extremely simply:
A drop down for the name (e.g. Elaine Jiang)
An input to select Date/Time
A drop down for a task (e.g. Kitchen, Breakfast, Library)
An input for a note (e.g. 'Fruit or Steam Bun', 'Wash Veggie')
And that's it. It would look nothing like what you posted, just a simple form with those 4 inputs. Again, that's because data output is a different function than data input.