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Safety Class Registration

Fill out the form below to register for the safety class that will be held Saturday March 6, 2010 from 8 am till 4:30 pm and Wednesday March 10,2010 from 6 pm to 9 pm at Klucker Hall Shiloh, IL.
Name of Student:
Date of Birth (mm/dd/yyyy):
/ /
Phone:

Address:
City:
State:
Zip:
Student's Email Address:
Name of Guardian (required for children under 13 yrs.):
Guardian's Email Address:
Guardian's Phone:
I would like to subscribe to Jake's Magazine for Youth from the National Wild Turkey Federation (available free to children 13 yrs. and younger.)
 
If you are attending as a guardian, will you also be taking the class for your IDNR Hunter Safety Card?
Yes No
 
If you answered YES, please provide the following information:
Date of Birth: (mm/dd/yyyy)
Address:
City
State
Zip: