Self Love Club 2025 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.

This 9-week program includes:

Weekly interactive sessions led by a Certified Community Health Worker
Engaging activities, group discussions, and self-reflection exercises
Tools for emotional regulation, decision-making, and self-advocacy
A safe, supportive, and culturally responsive space where girls can thrive
Weekly dinners are provided for each girl.

Program Dates: October 22 – January 7, 2026

Every Wednesday from 4:30 PM -5:30 PM

Grades: 4–8

Location: 120 Greenhill Ave, Wilmington, DE 19805

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

Parent Information Session (Required)

Parents/Guardians must attend one session before the program begins. Please select one date. You will receive a Microsoft teams meeting link via email.

October 8th, 2025 - 6:00 PM

October 9th, 2025 - 6:00 Pm

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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