Birthday Reveler Program - Westchester Volunteer Registration Form

Birthday Reveler Program - Westchester Volunteer Registration Form

Thank you for volunteering to bring joy to an older adult on their birthday!
Note that this form is for individual volunteers ages 18+ or High School students who will be accompanied by a parent/guardian.
Name*

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

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Preferred Phone #*
Is this preferred phone # a cellphone/mobile?*

YesNo
Secondary Phone #
Birth Date*

MonthDayYear
Gender*
Are you a student? *

High SchoolCollegeNo
Name of High School
Name of Parent/Guardian who will accompany you:*

First NameLast Name
Address of Parent/Guardian who will accompany you:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number of Parent/Guardian who will accompany you:*
Email of Parent/Guardian who will accompany you:*
example@example.com
I understand my parent/guardian will receive an email asking them to register for this program.*

Yes, I understand.
How did you hear about this program?*

DOROT Volunteer OrientationDOROT InviteDOROT WebsiteThe LOFTUJA Federation of New YorkUJA/J-TeenVolunteer NYYMSLFacebookInstagramFriend or FamilyOther
If Other, please specify:
Volunteers participating in the Birthday Reveler Program will be asked to pick up a birthday gift at DOROT’s office, 925 Westchester Avenue, Suite 200, White Plains, NY. Please choose the option that best suits your availability: (please note the office is closed Fridays, Saturdays and Sundays):*

I will arrange a specific time to pick up the gift between 9am-5pm on a Tuesday, Wednesday or Thursday and I would like the opportunity to meet a DOROT staff member in-person.I am not sure when I will arrive, please leave the gift at the front desk and I will pick it up during the week (Monday to Thursday) between 8am-5pm.
I acknowledge and agree to the bullet points below.*

Yes
I understand that:
- Volunteers for in-home visits must have previously participated in other DOROT in-home volunteer visiting activities or must attend a brief orientation to be scheduled directly with DOROT Westchester.
- Visits are expect to last between 30-45 minutes.
- Visits are expected to take place at a mutually agreeable time, after picking up the package from DOROT.
Please note that a government issued photo ID is required for all volunteers. Please provide the ID number from your government issued photo ID in the textbox below. Remember to have your ID with you when you come to DOROT. *
Type of ID*

Driver's LicensePassportOther
Driver's License State
Date of issue*

MonthDayYear
Date
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
Have you, since attaining the age of 18, been convicted of a criminal offense?*

YesNo
Today's Date

MonthDayYear
Date
Enter your initials*
Should be Empty: