7 - Week King Me Course Begins: Wednesday, September 30, 2026 from 6:00 pm-8:00pm
Location: Wakeman Boys & Girls Club 595 Madison Avenue Bridgeport, CT 06604 *For Boys in Grades 8-12*
Name
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Gender
*
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Male
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N/A
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
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Student E-mail
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example@example.com
Mobile Number
*
Format: (000) 000-0000.
School
*
Grade
*
Age
*
Course
*
Please Select
King Me - September 2026 Cohort
T-shirt Size
*
Please Select
XS
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XXXL
Hey, King! What do you hope to gain/ learn from this course?
*
This course is for you, even if you do not identify as a "KING"
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, job search, conflict resolution etc)? Feel free to share as much as you can, we are here to help!
Are you interested in an overnight retreat?
Yes
No
Maybe
How did you hear about this course?
Friend
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School
Wakeman Boys & Girls Club
Other
If other, tell us how.
Will you be able to commit to us for 7 weeks? Class will be every Wednesday starting September 30th - November 11th from 6:00pm to 8pm?
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I'm not sure
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Guardian/Emergency Contact Information
Parent/ Guardian/ Emergency Contact
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Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Email
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If this person does not have an email, please type "N/A"
Address
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If you want to add additional contacts, please use the space below.
Name, relation and phone number will suffice.
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