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Student Registration Form
Please complete each of the following questions to secure your spot in an Explore Bowhunting class. This information will only be used by Kentucky Fish & Wildlife for program administration and evaluation, and for communication with you about Explore Bowhunting and related opportunities. If you are under age 18, you must complete this form with a parent or legal guardian.

Pictures and Video may be taken as promotional material for the Explore Bowhunting program to be used by the Kentucky Department of Fish and Wildlife Resources. No personal information will be provided while marketing the program.
What is your age? (today)

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1. What is your age? (today)

Parent or Legal Guardian's Electronic Signature is required if you are under age 18. (Enter First and Last Name if applicable)

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2. Parent or Legal Guardian's Electronic Signature is required if you are under age 18. (Enter First and Last Name if applicable)

First Name:

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3. First Name:

Middle Initial:

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4. Middle Initial:

Last Name:

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5. Last Name:

Affiliation or Organization (organization/location through which you expect to participate in Explore Bowhunting, if known):

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6. Affiliation or Organization (organization/location through which you expect to participate in Explore Bowhunting, if known):

Address Line 1 (Street address or P.O. Box):

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8. Address Line 1 (Street address or P.O. Box):

Address Line 2 (if applicable):

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9. Address Line 2 (if applicable):

City (enter your complete city/town name):

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10. City (enter your complete city/town name):

ZIP Code (5-digit):

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12. ZIP Code (5-digit):

Phone number - with Area Code first; no dashes or parentheses.

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13. Phone number - with Area Code first; no dashes or parentheses.

Email address (must include username followed by @ sign, and end in .com, .net, .org, etc.):

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14. Email address (must include username followed by @ sign, and end in .com, .net, .org, etc.):

E-mail will be used as the primary means of contact, when possible.
Date of Birth (Month/Day/Year format)?

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15. Date of Birth (Month/Day/Year format)?

Date of Birth:
For example, January 1 1990 should be entered 01/01/1990
Social Security Number (SSN): Last 4 Digits

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16. Social Security Number (SSN): Last 4 Digits

Note: SSNs will be converted to a unique identification number and NOT distributed nor permanently held. This is the same process we use to create ID numbers for hunting and fishing licenses.
Have you ever gone hunting?

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17. Have you ever gone hunting?

Have you ever gone fishing?

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18. Have you ever gone fishing?

Have you ever purchased a hunting or fishing license of any kind (or has one been purchased for you)?

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19. Have you ever purchased a hunting or fishing license of any kind (or has one been purchased for you)?

Are you interested in receiving information about hunting opportunities for new hunters, such as special hunts and mentored hunting programs?

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20. Are you interested in receiving information about hunting opportunities for new hunters, such as special hunts and mentored hunting programs?

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