Splash Screen/Viewer Information

Hi there

I have a page on a wordpress site where people are able to view a live stream of a church service or event we are running. At present I have placed a yshout box on it to engage with people, however this doesn’t help gather much information as not everyone chats on it. I would like it that prior to folks being able to view the live stream that they enter in some basic details like name and location which would then be stored somewhere so it can be viewed. There would naturally be a button for people to click to say no, just take me to the stream, but then still count it as a stat.

Is there anything out there that would do this?

Thanks

Colin