Aiken Queer Youth Club 
Important: This form is for youth (6th to 12th grade) wishing to attend Aiken Queer Youth Club meetings or events. 

Please completing this form to the best of your ability. All information provided should describe the YOU, since you will be attending, not your parents, guardians or caregiver.

A staff member will contact the youth after the form is complete. Please include contact information (email and phone number) that is safe for a staff member to use to contact you. 

Thank you in advance for your patience and diligence in completing the form with accuracy. 
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Email *
How did you learn about Aiken Queer Youth Club?
What is your date of birth (including year)?
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Are you in:
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What is your chosen first name (the name you would like to be called)?
What is your chosen last name (the name you would like to be called)?
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Is your legal name the same as your chosen name? If not, please write your full legal name, which will be kept confidential.
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Required
Pronouns are used as a way to identify or refer to someone. Common examples of pronouns include they/them/theirs, she/her, and he/him, among many others. What are your pronouns?
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Required
What is a safe phone number a Aiken Queer Youth Club staff member can use to reach you?
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What is your email address? This is the email we will use to send you program information. 
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Sexual orientation 
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Required
Do you identify with being Intersex? Intersex is a general term used for a variety of situations in which a person is born with reproductive or sexual anatomy that does not fit the typical binary notions of male or female bodies. More Information about Intersex People *
Gender Identity refers to how you see yourself. It is an internal and personal experience. When you think of your gender identity, select any of the terms that describe you. 
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Required
Where do you go to school? 
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What grade are you in currently? (If completing during the Summer, what grade are you going into?)
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Do you have any food allergies we need to be aware of? (if no, write none) *
Do you have any medical conditions we need to know about? If you are a person with a disability or medical condition and require a reasonable accommodation, please let us know what support services you need here. (If no, write none.)
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