You can create simple form using textview and edittexts in Linear Layout with vertical orientation and use list view to display items stored.
Go through these examples - http://chintankhetiya.wordpress.com/2013/06/01/sqlite-database-example/ to store data and http://www.androidhive.info/2012/02/android-custom-listview-with-image-and-text/ to display data in listview.