Self Love Club 2026 Fall Registration

Self Love Club After School Program is designed to address youth mental health by equipping girls with emotional resilience, leadership skills, and a strong sense of self-worth. Over 80% of our girls left the program with greater confidence to speak up—whether through reading aloud, participating in group discussions, or sharing their thoughts in journaling.

Your daughter will gain:

Tools to handle stress and manage big emotions
Confidence to advocate for herself
A supportive community of peers
Skills for personal growth and academic success
Weekly dinners are provided for each girl.
- Led by a certified Community Health Worker

Program Dates: March 11 – May 13, 2026

Every Wednesday from 5:15 PM - 6:15 PM

Grades: 4–8

Location: 120 Greenhill Ave, Wilmington, DE 19805

Registration Fee: $35

We’re so excited to welcome your daughter to the Self Love Club! Please complete this form to secure her spot.

Student Information

Student's Full Name

Birthday

Month

Day

Year

Current Grade

School

Medical/Allergy Information

Please list any relevant medical concerns, allergies, or special accommodations.

Parent/Guardian Information

Parent/Guardian Name

Phone Number

Emergency Contact

Full Name & Relationship

Phone Number

Emergency Contact Phone Number

Which area do you feel your child needs the most support in right now? (Choose one or more)

Self-Esteem & Self-Confidence

Self –Awareness & Positive Decision Making

Self-Expression & Emotional Regulation

Healthy Coping Mechanisms & Stress Reduction

How did you hear about us?

Consent & Agreements

I give permission for my child to participate in the Self Love Club After School Program.

I understand that participation requires attending one Parent Information Session.

I give permission for my child’s photo/video to be used for program documentation and promotional purposes. (Optional)

Signature

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Registration Fee

$35