Courageous Queen: SEL & Menstrual Health Empowerment Program Registration

The Courageous Queen SEL and menstrual program empowers girls ages 9+ with the knowledge, confidence, and self-care practices needed to navigate their menstrual cycles with ease. Participants will embrace their transition into womanhood with self-awareness, clarity, and confidence.

Topics include:

When:

Tuesday's, Jan 20 - Feb 17

Time:

4pm-530pm

Where:

Heilmann Recreation Center

19601 Crusade St Detroit, Mi 48205

Included:

-ALL program materials

-Courageous Queen Swag Bag w/ hygiene and self-care products upon program completion

There is NO REGISTRATION fee =) 15 spots available

Want to be a Courageous Queen Sponsor? Below is more information

Courageous Queen Sponsorship Deck

Courageous Queen Sponsor Link

Please complete this form to confirm attendance. Registration is on a first-come, first-served basis.

Student's Information:

First Name

Last Name

Birthday

Month

Day

Year

Address

Grade Level

3rd - 5th

6th - 8th

9th - 12th

School Name

Have your student received their "period" yet?

Yes

Parent/Guardian Information

Relationship to child:

First name

Last name

Address

Phone

Health Information

All fields are required below. If nothing applies, please put "NONE" in the box. Thanks.

Are there any allergies, medical considerations, or accessibility needs we should be aware of?

Yes

If yes, please explain below:

Is there anything you would like the facilitator to know to best support your child during this program?

Consent & Acknowledgment

Please review and acknowledge the following:

(Checkboxes – REQUIRED)

I give permission for my child to participate in the Courageous Queen Program.

I understand this program includes age-appropriate discussions about body awareness, emotional wellness, and menstrual health.

I understand this program is educational and not medical or therapeutic care.

Media Release

Media Permission

I give permission for photos/videos to be taken for educational or promotional purposes

I do NOT give permission for photos/videos

Program Impact

What do you hope your child gains from the Courageous Queen Program?

Signature

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Want to be a Courageous Queen Sponsor? Below is more information

Courageous Queen Sponsorship Deck

Courageous Queen Sponsor Link