WCH - Rosh Hashanah Package Delivery 2025 - Adults and Family Volunteer Form

DOROT's Rosh Hashanah Package Delivery - Westchester Volunteer Registration Form

Sunday, September 14, 2025
For more information, please visit our website HERE.
Are you volunteering as:*

AdultFamily with children ages 10 - 17
Parent/Guardian 1 Name*

First NameLast Name
Parent/Guardian 1 Address*

Street Address

Apartment (If Applicable)

CityState

Zip Code
Name*

First NameLast Name
Address*

Street Address

Apartment (If Applicable)

CityState

Zip Code
Email*
example@example.com
Primary Phone #*
Secondary Phone #
Birth Date

MonthDayYear
Gender:*
Parent/Guardian 2 Name (complete if the person will also participate.)

First NameLast Name
Parent/Guardian 2 Address (if different from above)

Street Address

Apartment (If Applicable)

CityState

Zip Code
Parent/Guardian 2 Email
example@example.com
Parent/Guardian 2 Phone Number
Parent/Guardian 2 Birth Date

MonthDayYear
Parent/Guardian 2 Gender:
Child 1 Name*

First NameLast Name
Child 1 Birth Date*

MonthDayYear
Child 1 Age*
Child 1 Gender:*
Child 1 Email (if applicable)
example@example.com
Additional Children
Are you a student?*

High SchoolCollegeNo
How did you hear about THIS Package Delivery event?*

DOROT EmailDOROT WebsiteFriend/Family/NeighborSocial MediaUJA Federation of New YorkAdvertisementVolunteer NYYoung Men's Service LeagueOther
If Other, please specify:
I will volunteer to visit an older adult in their home.

I will deliver a package to an older adult and stay for a 30 - 45 minute in-person visit on Sunday, September 14th. I will pick up the package at DOROT’s office, 925 Westchester Avenue, Suite 200, White Plains, NY on Sunday, September 14, between 10:30 am – 12:00 pm. I understand the older adult is expecting me to visit before 1:00 pm.
I acknowledge and agree to the bullet points below.*

Yes
I understand that:
- Visits are expected to take place on Sunday, September 14, immediately after picking up the package from DOROT.
- The older adult is expecting the in-home visit before 1:00 pm.
- Volunteers for in-home visits must have previously participated in other DOROT in-home volunteer visiting activities or must attend a 30-minute Zoom orientation on Tuesday, September 9th, at 5:30 pm (details to follow in a separate email).
- Visits are expect to last between 30-45 minutes.
- Visits are not guaranteed but based on availability.
I have volunteered for a DOROT Package Delivery in the past.*

YesNo
A government issued photo ID is required for all volunteers age 18+. 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
Expiration Date*

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*
A photographer will be taking pictures of the event. Please know that by participating, you may be photographed and your imagine may be used in DOROT’s public relations and fundraising materials. If you don’t wish to be photographed, please let the photographer know.

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

DOROT's Rosh Hashanah Package Delivery - Westchester Volunteer Registration Form