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

October 22, 29

November 5, 12, 19 (skip Nov 26)

December 3, 10, 17
Name*

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

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Preferred Phone Number*
Is this Preferred Phone Number a cell/mobile phone?

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

Last Updated 8/2025
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DOROT Westchester Intergenerational Chess Application for Adults 60+

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