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.
Name(Required)
Sign-up for the Racine Youth Support Group?(Required)
Racine Queer Youth Group | Thursdays, 5-6 pm
Sign-up for the Racine Youth Art Night?(Required)
Racine Queer Youth Art Nights | Third Thursdays, 5:30-7 pm
Sign-up for the Kenosha Youth Support Group?(Required)
Kenosha Queer Youth Art Nights | First Wednesdays, 5:30-7 pm
Sign-up for the Kenosha Youth Art Night?(Required)
Queer Youth Art Nights (Kenosha)
What grade are you in?(Required)
What pronouns do you use?(Required)
Check all that apply.
How do you identify?(Required)
Check all that apply.
How do you identify?(Required)
Check all that apply.
Do you need accomodation for a disability?(Required)
Check all that apply, even if you are self-diagnosed.

Parent or Guardian Information

Are you out to your parent or guardian?(Required)
Does your parent or guardian know you are attending this group?(Required)
Parent or Guardian's Full Name(Required)

Your Feedback

Is there anything else that you’d like us to know?
Is there anything else that you’d like us to know?
Your Consent(Required)
This field is for validation purposes and should be left unchanged.

Masking Notice

We strongly encourage masks to be worn in the Center.