DOROT Westchester Intergenerational Chess Application for High School Students

DOROT Westchester Intergenerational Chess Application for High School Students
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.

By registering, you are committing to all 8 sessions.

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 a cell/mobile phone?

YesNo
Birth Date*

MonthDayYear
Gender*
Name of School*
School Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Current Grade*
Parent/Guardian 1
Name*

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

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent Preferred Phone Number*
Is this parent's preferred phone a cell/mobile phone?

YesNo
Parent/Guardian 2
Name

First NameLast Name
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
How did you hear about this program?

ParentSiblingGrandparent or GrandrelativeSynagogueSchoolReturning ParticipantSocial MediaDOROT WebsiteOther
Do you have any food allergies?*

YesNo
If yes, please describe.
Do you have an existing medical condition or special needs?*

YesNo
If yes, please describe.
What is your chess playing experience?*

NewBeginnerIntermediateAdvanced
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 High School Students

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