Building Kings & Queens Intake Form
Welcome to BKQ! Please fill out the form below to sign up as an official member of our organization. We will contact you with updates and events shortly.
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Tell us about yourself :)
Legal Name *
What is your preferred name? (If you prefer to use your legal name, leave this answer blank) *
What email is best to reach you? *
What is your date of birth? *
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YYYY
How do you identify? *
What are your preferred pronouns? *
What is your home address? *
Do you consent to receive emails? (We never spam and only send emails to notify you of BKQ events or updates) *
What is the best number to reach you? *
Do you consent to receive occasional text messages? *
Who is your best emergency contact? (Enter their legal name) *
What is your emergency contact's relation to you? *
Please add your emergency contact's phone number. *
What is your country of origin? *
What is your ethnicity/race? *
What is your primary religious affiliation? *
What is your primary language? Do you speak a second language? If so, please specify. *
What grade level are you in? *
What is your employment status? *
Are you taking any medications? *
If yes, which medications do you take? (If no, leave this answer blank.)
Is there anything else you think we should know about you? *
Tell us one fun fact about you ;) *
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