She's Crowned Registration Form

Course Begins: Wednesday, March 22, 2023 from 5:30pm-7:30pm

Location: 25 Van Zant Norwalk, CT. 06855 4th floor - *HIGH SCHOOL GIRLS ONLY*
Name*

First NameMiddle NameLast Name
Birth Date*

MonthDayYear
Gender*
Please select "N/A" if you do not identify with the options listed.
If you selected "N/A" please tell us how you identify.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student E-mail*
example@example.com
Mobile Number*
Format: (000) 000-0000.
School*
Grade*
Age*
Course*
T-shirt Size*
Hey, Queen! What do you hope to gain/ learn from this course?*
This course is for you, even if you do not identify as a "QUEEN"
What should we know about you?
Example: Are you shy or outgoing? Do you want to meet new friends? Do you have any struggles we can help with (i.e. self esteem, body image, confidence etc)? Feel free to share as much as you can, we are here to help!
FriendFamily MemberMentorSocial MediaSchoolOther
If other, tell us how.
Will you be able to commit to us every Wednesday starting March 22nd - May 3rd from 5:30pm to 7pm for 7 weeks?

Guardian/Emergency Contact Information