Youth Volunteer Middle School Registration

Youth Volunteer Middle School Registration
Please note this form is for Middle School youth, grades 6th - 8th.
Youth Volunteer Name*

First NameLast Name
Youth Volunteer Birth Date*

MonthDayYear
Grade

6th7th8th
Name of School*
Type of School*

PublicPrivateCharterIndependentOther
Gender
What Pronouns do you use

she/her/hershe/him/histhey/them/theirsOther
Parent/Guardian 1 Name *

First NameLast Name
Parent/Guardian 1 Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Phone # *
Secondary Phone #
Parent/Guardian 2 Name

First NameLast Name
Parent/Guardian 2 Email
example@example.com
Primary Phone #
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
My child will participate in the Intergenerational B-Mitzvah Program, Sundays 1:30 PM - 3:00 PM on the following dates (check all that apply):

03/19/2304/23/2305/21/23We are interested in being matched with an adult for home visits on our own schedule.
Is there anything you would like us to know about the volunteer?
I heard about DOROT's BMitzvah Program from:*

DOROT emailDOROT websiteWebsite SearchSynagogueChildren’s SchoolDoing Good TogetherA friend/family memberOther
DOROT's Terms of Service

DOROT prides itself on providing quality programs and our efforts to ensure the safety and well-being of volunteers and older adults. As a DOROT volunteer, I accept and will adhere to the following standards of behavior when engaged in volunteer activities. I understand that DOROT may terminate my volunteer engagement at any time for any reason including failure to follow these guidelines.
- I will participate in required training programs, follow all rules and use the recommended policies and procedures;
- I will adhere to all local, State and Federal laws and behave with the highest level of professionalism and integrity in all of my interactions with clients, staff and other volunteers;
- I will preserve the confidentiality of information about program participants that has been entrusted to me;
- I will not use DOROT volunteer status for personal, business or financial gain.
I agree to DOROT's Terms of Service for volunteers. *

Yes
Date

MonthDayYear
Date
Youth Volunteer Full Name*
Enter your initials *
Please check your responses carefully for accuracy. You will not be able to revise this form after submission.
Should be Empty:

Youth Volunteer Middle School Registration

DOROT's Terms of Service