DOROT Westchester Intergenerational Chess Application for Adults 60+

DOROT Westchester Intergenerational Chess Application for Adults 60+
We're glad you've chosen to register for DOROT's Intergenerational Chess Program at the Leffell School in Hartsdale.

Sessions are on Wednesdays from 4:30pm to 6pm.

Commitment of 8 weeks.

The program dates are

January 28

February 4, 11, 25 (skipping February 18)

March 4, 11, 18
Name*

First NameLast Name
Preferred Email*
example@example.com
Preferred Email Type:*

HomeWorkOther
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Preferred Phone Number*
Preferred Phone Number Type:

HomeMobileWorkOther
Alternate Phone:
Birth Month
Birth Day
Birth Year*
Adult Participants - 60+
Gender*
Emergency Contact
Name*

First NameLast Name
Phone Number*
Relationship*
What is your chess playing experience?*

NewBeginnerIntermediateAdvanced
What accommodations, if any, do you need us to be aware of? (Allergies, mobility, etc.)
How did you hear about this Intergenerational Chess Program?

DOROT Westchester e-newsletterDirect MailDOROT WebsiteReturning ParticipantLeffell SchoolFriend/FamilyWestchester Senior VoiceOther
Have you, since attaining the age of 18, been convicted of a criminal offense? (Conviction will not disqualify you from volunteering unless there is a direct relationship to the volunteer task or your volunteer activity would pose an unreasonable risk to property or safety.) *

YesNo
I understand that as a DOROT volunteer it is my responsibility to:
Attend all sessions of the program.*

Acknowledged and agreed.
Arrive on time; stay for the full session.*

Acknowledged and agreed.
Make an effort to get to know all the other participants.*

Acknowledged and agreed.
Agree to focus on relationships, learning and fun, not competition.*

Acknowledged and agreed.
Use the game of chess as a way to enjoy intergenerational connections.*

Acknowledged and agreed.
Behave in a respectful way with everyone.*

Acknowledged and agreed.
I give DOROT, Inc. the irrevocable right to take and use my name, picture, likeness, photograph, film, videotape, and/or verbal or submitted written statement in all forms and media and in all manners for any editorial, promotional, fundraising, internet (website) and/or publicity purposes of DOROT, Inc. I understand that I may be identified by name, age and/or occupation in connection with the public, private and/or internal use of this material. I grant this consent as a voluntary contribution to DOROT, Inc. and waive any rights I may have in connections with any use of the material, including any right to inspect or approve the finished use, including any written copy that may be created in connection with such use.*

YesNo
For questions - infowestchester@dorotusa.org or (914) 485-8354

Last Updated 12/2025
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DOROT Westchester Intergenerational Chess Application for Adults 60+

I understand that as a DOROT volunteer it is my responsibility to: