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How to make a form in Android with name, image and date

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http://stackoverflow.com – I have got some troubles with my app. I need to have a form like you use in HTML with possibility to put some data to a server. For example i want to put Name,date and image to a server. It should work like it does with HTML forms. Some user inserts name, date and choose an image from smartphones gallery and then touch some button and then data goes to a server. It´s not difficult to upload name and date datas together, but i dont know how i can put an image to a server at the same time as the two other variables ?? I hope someone can help me. Can't find anything about this issue... Thanks (HowTos)