2024 DOROT Light One Night Family Visits

DOROT's Light One Night Home Visits

Online registration closes on Monday, December 16th
Register here to receive a package and a visit or call from a DOROT family with children 5 years and older.
Parent/Guardian 1 Name:*

First NameLast Name
Parent/Guardian 1 Email:*
example@example.com
Birth Date:*

MonthDayYear
Address:*

Street Address

Apartment

CityState / Province

Postal / Zip Code
Address:*
Apartment (if applicable):
Primary Phone # *
Secondary Phone #
Parent/Guardian 2 Name (Complete if the person will also participate. DOROT will automatically send this person a volunteer profile form to complete.)

First NameLast Name
Parent/Guardian 2 Email:
example@example.com
Birth Date:

MonthDayYear
Primary Phone #
Address (if different from above):
Apartment (if applicable):
Address (If different from above):

Street Address

Apartment

CityState / Province

Postal / Zip Code
1. Child 1 Name*

First NameLast Name
Child 1 Age*
1. Child 1 Birth Date*

MonthDayYear
2. Child 2 Name

First NameLast Name
Child 2 Age
2. Child 2 Birth Date

MonthDayYear
3. Child 3 Name

First NameLast Name
Child 3 Age
3. Child 3 Birth Date

MonthDayYear
4. Child 4 Name

First NameLast Name
Child 4 Age
4. Child 4 Birth Date

MonthDayYear
My family and I would like to register to deliver a package and:*

Call later for a telephone visit with the senior for Hanukkah.Visit in-person in the adult's home
DOROT's clients live in Manhattan between 20th St - 110th St. Do you prefer to deliver your package on:*
I have volunteered with DOROT before *

YesNo
If you answered ‘Yes’ to the previous question, please list the last DOROT volunteer event in which you participated:
I heard about DOROT’s Light One Night from:**

DOROT EmailDOROT WebsiteWebsite SearchSynagogueChildren’s SchoolDoing Good TogetherA Friend/Family memberOther
Have you, since attaining the age of 18, been convicted of a criminal offense?*

YesNo
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
Enter your initials *
We appreciate you volunteering to make and deliver a holiday package for a DOROT senior! While some seniors would like a home visit with a fmaily it is not guaranteed. Please keep an eye on your email for further instruction about what to include in the package and how to connect with your match.

Please check your responses carefully for accuracy. You will not be able to revise this form after submission.
Should be Empty:

DOROT's Light One Night Home Visits

DOROT's Terms of Service