HelpLine DC-YLC APPLICATION Form

HelpLine DC-YLC Ice Cream Social Permission Form
HelpLine Delaware County Youth Led Council (DC-YLC) is excited to host our first annual ice cream social for interested students. Join us on Sunday, Sept. 15, 2024 from 1 p.m. to 2:30 p.m. to learn more about the council, connect with other interested students, and enjoy some ice cream!

The ice cream social will be held near downtown Delaware. Once you have completed the registration, we will send the location via email.

To join us, please complete the interest form below and have your parents and/or guardian sign the form as well. Please note that parental and/or guardian permission is required to attend.

Questions? Contact HelpLine Youth Empowerment Coordinator, Jackie Lipnos, at jlipnos@helplinedelmor.org.

NOTE: If you are unable to make it to the ice cream social but interested in the council, please complete this form and we will send you all the necessary information via email.

Student Information
Full Name of Student*

First NameMiddle NameLast Name
Email*
High School Name*
Grade*
Do you have any dietary restrictions?*

YesNo
Please share your dietary restrictions below:
Are you able to attend the ice cream social on Sept. 15, 1 p.m. to 2:30 p.m.*

Yes, I will be there!I can’t make it (don’t worry, we will send you all the information that we cover!)

Parent/Guardian Information
Parent/guardian permission is required to attend the ice cream social event. Please fill in the following information and tell your guardian to look for an email from HelpLine to complete the necessary forms.
Name*

First NameLast Name
Email*
example@example.com
Date*

MonthDayYear
Date
Please verify that you are human*
Should be Empty: