Custom Wordpress Blog - 3 Pages

I need a 3 page custom wordpress template that I can upload to my existing blog. -I am not looking for fancy design for the site. I need somewhat of a minimalist design. I want the color scheme of the site to be somewhat similar to this: [login to view URL] -The pages will be the: Home, Personal Training, Contact - That is the order I want it in -I need to be able to upload a youtube video to the main page like this website: [login to view URL] -Above the video on the main page should say "Pasadena Personal Trainer" in large text. and to the right of it, it should say "Lose 10 lbs In Your 1st Month" - I want to be able to have the ability to change the text for both of these if I want to. -I need an opt in box to the right of the video, I also need to be able to change the text within the opt in box. It should look like this: [login to view URL] -I want to be able to collect "Name" and "Email" in the opt in boxes -The buttons for the opt in boxes where the customer clicks to send their information should be the color orange and it should say "Click Here" -All pages of the blog should be full width pages -I do not want comments allowed on the blog -I want to be able to write text below the video -I want another opt in box that I can write text in at the bottom of the page, it will go below the testimonials. -I want to be able to have at least 3 revisions -The bottom of the main page should have an area where I can include links for other cities like this: [login to view URL] -The links of the other cities should be "South Pasadena Personal Trainer" "Altadena Personal Trainer" "La Canada Personal Trainer" "San Marino Personal Trainer" "Glendale Personal Trainer" "Arcadia Personal Trainer" and "Privacy Policy" - All these links can lead to empty pages. I will build the pages myself.