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Menu
The Center+
About Us
Contact Us
Funders
Staff & Board
Mission & Vision
Privacy Policy
Accessibility Statement
Programs
Advocacy
Events
Upcoming Events
Safe Zone Training
Support Groups
WI Trans Healthcare Directory
Take Action
LGBTQ Events in SE Wisconsin
Advocate
Participate
Volunteer
Monthly Newsletter
Resources
Provider Directory
Sign Up
Donate
Sign-Up for Youth Groups
Youth Group Sign-Up Form
Are you in grades 6-12? This is where you sign-up to attend our Queer Youth Groups.
About You
Your unique identity is important, and we want to know who is in our community! Please answer the following questions that will guide us in building equitable programs for everyone. Anything you share in these groups, and especially your queer identity, will be kept private by our adult group leaders. The only exception is if you or someone close to you is at risk of harm. In that case, we may contact your parent, guardian, or school to get you the best support possible.
Preferred name (Optional)
Email
(Required)
Name
(Required)
First
Last
Cellphone (Optional)
Sign-up for the Racine Youth Support Group?
(Required)
Racine Queer Youth Group | Thursdays, 5-6 pm
Yes
No
Sign-up for the Racine Youth Art Night?
(Required)
Racine Queer Youth Art Nights | Third Thursdays, 5:30-7 pm
Yes
No
Sign-up for the Kenosha Youth Support Group?
(Required)
Kenosha Queer Youth Art Nights | First Wednesdays, 5:30-7 pm
Yes
No
Sign-up for the Kenosha Youth Art Night?
(Required)
Queer Youth Art Nights (Kenosha)
Yes
No
What school do you go to?
(Required)
What grade are you in?
(Required)
6th
7th
8th
9th
10th
11th
12th
What pronouns do you use?
(Required)
Check all that apply.
They/them
She/her
He/him
Prefer not to answer
Other (I’ll add my response in the Comment Box below)
How do you identify?
(Required)
Check all that apply.
Asexual
Bisexual
Gay
Intersex
Lesbian
Pansexual
Queer
Straight
Transgender / Nonbinary
Prefer not to answer
Other (I’ll add my response in the Comment Box below)
How do you identify?
(Required)
Check all that apply.
Asian / Pacific Islander
Black / African Descent
Latinx
Native American / Indigenous
White / Caucasian
Mixed
Prefer not to answer
Other (I’ll add my response in the Comment Box below)
Do you need accomodation for a disability?
(Required)
Check all that apply, even if you are self-diagnosed.
No, I do not require accommodation
Wheelchair accessibility
Subtitles / captions
ASL interpreting
Sensory accommodations (dim lights, quiet spaces, etc.)
Tone tags in written communication (/j for joking, /s for serious, etc.)
Prefer not to answer
Other (I’ll add my response in the Comment Box below)
Parent or Guardian Information
Are you out to your parent or guardian?
(Required)
Yes
No
Does your parent or guardian know you are attending this group?
(Required)
Yes
No
Parent or Guardian's Phone
(Required)
Parent or Guardian's Phone
(Required)
Parent or Guardian's Full Name
(Required)
First
Last
Your Feedback
Is there anything else that you’d like us to know?
Comment Box (Optional)
Is there anything else that you’d like us to know?
Your Consent
(Required)
I consent to share my personal information with — and receive communications from — the LGBT Center of SE Wisconsin, as detailed in the Privacy Policy.
I agree with the
Privacy Policy
Phone
This field is for validation purposes and should be left unchanged.