★ Youth Interest Form ★

YOUR VOICE
HAS THE
POWER TO LEAD,
LEARN & SHARE.

There's a place for you here. Come lead, learn, share or simply participate. We can't wait to meet you.

📍

Where We Are

296 Park Ave, Bridgeport, CT 06604, right on the University of Bridgeport campus.

💡

What We Do

We build leaders through workforce readiness, mentorship, creativity, credentialing and community connection.

❤️

Why We Do It

Youth deserve spaces that invest in them, celebrate them, and open doors they didn't know existed.

🗓️

Fall & School-Year Hours: Tuesday – Thursday, 3:00 – 7:00 PM, plus select weekends for events & activities (times shared as each one is scheduled).
Programming wraps at 6:30 PM, and all students should be picked up or headed home by 7:00 PM.
Tell us what works for your schedule and we'll build around it.

WHY THIS MATTERS FOR YOU

Build real job readiness and workplace skills you can put on your résumé
Lead something real: a cohort, a workshop, a creative session, or a talk about your passion
Learn new skills alongside mentors and peers, from career prep to creative arts
Gain essential life skills you'll carry with you wherever life takes you, from communication and time management to managing money
Share your hobbies, talents and story with a community that wants to hear it
Log documented volunteer hours for school and community service, with limited paid stipend opportunities for select roles
Stand out on college applications, scholarships, portfolios and job searches

🌟

YOU'RE ON YOUR WAY!

Thank you for your interest in joining The House of Darla. We're so excited to connect with you. Someone from our team will reach out within a few days to talk next steps. Get ready: your moment is coming.

🧭 How Do You Want to Show Up?

Choose one or more. There's room for everyone here. *

🚀 LEAD Run a cohort, host a workshop, mentor peers or guide a project. 📚 LEARN Join programs, build new skills and grow with mentors and peers. 🎤 SHARE Bring a hobby, talent or story as a guest speaker or creative session. 🧩 PARTICIPATE Join activities and events, explore what we offer, and find your fit.

🙋 About the Student

First Name *

Last Name *

Age *

Grade / Year

Pronouns

School Attending *

City / Town *

Student Phone *

Student Email *

Languages Spoken

T-Shirt Size *

👨‍👩‍👧 Parent / Guardian

Required for students under 18.

Guardian First Name *

Guardian Last Name *

Relationship to Student *

Best Phone Number *

Email Address *

Best Way to Reach You

📞 Call 💬 Text 📧 Email 🙌 Any

🛟 Emergency Contact & Health

Contact Name *

Relationship *

Phone *

Allergies, Medical or Accessibility Needs

Shared only with staff who need it to keep the student safe.

🚀 Goals & Permission

What do you hope the student gains from this experience?

How did you hear about The House of Darla?

Photo & Media Release *

May The House of Darla use photos or video of the student in our newsletters, website, social media and promotional materials?

Yes, and you may include their first name Yes, but please don't include their name No photos or video, please

📸 Photos and video may be taken during select events and activities. If you choose "No," we'll do our best to keep the student out of photos and will never post an image where they can be identified. Because some events are large or public, we can't guarantee they'll never appear in the background of group shots.

Once submitted, a member of our team will reach out within a few days to connect, answer questions, and co-create this opportunity with you.
We can't wait to meet you. 🌟

YOUR VOICE HAS THE POWER TO LEAD, LEARN & SHARE.

THE OPPORTUNITY

WHY THIS MATTERS FOR YOU

YOU'RE ON YOUR WAY!

YOUR VOICE
HAS THE
POWER TO LEAD,
LEARN & SHARE.