DOROT’s B-Mitzvah Experience Registration 2025

DOROT’s B-Mitzvah Experience Registration

Thank you for your interest in DOROT’s B-Mitzvah Experience! This program is for youth who will have a B-Mitzvah between June 2026 and January 2027. Space is limited.
Youth Volunteer Name*

First NameLast Name
Youth Volunteer Birth Date*

MonthDayYear
When is your BMitzvah*

MonthDayYear
When is your B-Mitzvah?
Grade

5th6th7th
Name of School*
Type of School*

PublicPrivateCharterIndependentOther
Gender*
Gender if not listed above
What Pronouns do you use

she/her/hershe/him/histhey/them/theirsOther
Does your family belong to or attend a synagogue?

YesNo
If yes, which synagogue/minyan/havurah? Choose all that apply.

Carlbach ShulCentral SynagogueCongregation Ansche ChesedCongregation Beth Simchat TorahCongregation B'nai JeshurunCongregation Emanu-El of the City of New YorkCongregation HabonimCongregation Kehilath JeshurunCongregation Ohab ZedekCongregation Or ZaruaCongregation Ramath OrahCongregation Rodeph SholomCongregation Shaare ZedekCongegation Shearith IsraelConservative Synagogue of Fifth AvenueLincoln Square SynagoguePark Avenue SynagoguePark East SynagogueRomemuSAJStephen Wise Free SynagogueSutton Place SynagogueTemple Israel of NYCTemple Shaaray TefilaThe Jewish CenterWest End Synagogue
Have you participated in DOROT's B-Mitzvah Experience Program before?

YesNo
Parent/Guardian 1 Name *

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

Street Address

Apartment (if applicable)

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

Apartment (if applicable)

CityState / Province

Postal / Zip Code
Is there anything you would like us to know about your child?
I heard about DOROT's BMitzvah Program from:*

DOROT EmailDOROT WebsiteWebsite SearchSynagogueChildren’s SchoolFamily/Friend/NeighborDugmahWest Side RagEast Side FeedOther
DOROT's Terms of Service

DOROT prides itself on providing quality programs and on our efforts to ensure the safety and well-being of volunteers and older adults. As a DOROT Parent, I accept and will assist my child in adhering to the following standards of behavior when engaged in volunteer activities. I understand that DOROT may terminate my childs volunteer engagement at any time for any reason including failure to follow these guidelines.

My child will:
- Participate in required training programs, follow all rules and use the recommended policies and procedures;
- Adhere to all local, State and Federal laws and behave with the highest level of professionalism and integrity in all of their interactions with clients, staff and other volunteers;
- Preserve the confidentiality of information about program participants that has been entrusted to them;
- Attend all sessions, Sundays, 4:00-5:30 PM; 3/01, 03,08, 03/15, 4/12, 4/19, 4/26, 5/3 at DOROT, 171 West 85th Street, NYC (some sessions may be off site)
I agree to DOROT's Terms of Service for volunteers. *

Yes
Questions? Contact us at teens@dorotusa.org or 917-441-5040

Please check your responses carefully for accuracy. You will not be able to revise this form after submission.
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DOROT’s B-Mitzvah Experience Registration

DOROT's Terms of Service