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Enrollment Date*

Student's Full Name*

Grade*

Home Address*

City*

Zip*

Gender*

MaleFemale

County Residence*

Township of Residence*

Birth Date*

Age*

Birth City*

Birth State*

Name of Parent(s)/Legal Guardian(s)*

Relationship*

Phone*

Cell:

Name of Parent(s)/Legal Guardian(s):

Relationship:

Phone:

Cell:

Parent/Guardian Email*

Student Email:

Cell Phone:

Last School Attended:

Have you ever attended a public school?*

YesNo

If so, when and where?

Phone Number of School:

School Address:

City:

State:

Zip:

Do you have an IEP or 504 plan?*

If Yes, please give a brief description of the IEP or Section 504 plan.*

YesNo

Student Signature*

Parent/Guardian Signature*

Date*

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Our Team

KFDC STAFF

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laudantium, totam rem aperiam.

Brian Rajdl

A nature enthusiast, wilderness adventurer, guide and mentor. Brian’s path in life is to teach and mentor students and adults about the diverse wonders of our natural world, opening pathways for others to safely…

Susan Nielsen

Come to Susan when you have questions about funding; when you are concerned about an issue with your student; when you have an idea that would help the center; when you want to get a pep talk about…

Heaven Hawkins

Hello all, I am Heaven Hawkins. I will be the new administrative assistant, please come to me with questions, concerns or a friendly conversation! Being someone who has attended and thrived in…

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