Multiple predefined amounts blocks in 1 donation

Hi,

I would like to add multiple predefined donation amounts categories in a one donation form. Its for a donation form where we have three categories of donation; child, normal, elderly.

For each category I want a drop down quantity, 0-5 people, then three amounts as radio buttons.

I've attached an image as trying to describe these things is a little tricky.

Do I need an extra plugin for this?

Big thanks,

Raquel