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 7 sessions.

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
Email for Reminders:
IF teen registers by PHONE but does provide an email for SF account.
Preferred Email Type:*

PersonalWorkOther
Address*

Street Address

Street Address Line 2

CityState / Province

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

HomeMobileWorkOther
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*
Parent's Preferred Phone Type:*

HomeMobileWorkOther
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
Terms of Participation:
Terms of Participation:

Before we finish your registration, I need to read you a brief statement about program content. This is the same agreement participants see when registering online. It explains that all program materials belong to our organization and can’t be used or shared without our permission. After I read it, I’ll ask if you agree so we can complete your registration.
The content of this program is the property of DOROT, Inc. and is intended solely for the personal, non-commercial use of authorized participants. All rights are reserved. Any recording, screen scraping, copying, storage, display, or distribution of this content without DOROT, Inc.'s express written permission is strictly prohibited. Unauthorized use may subject violators to civil and criminal penalties.*

I agree to these terms.
DOROT staff, read this to participant: The content of this program is the property of DOROT, Inc. and is intended solely for the personal, non-commercial use of authorized participants. All rights are reserved. Any recording, screen scraping, copying, storage, display, or distribution of this content without DOROT, Inc.'s express written permission is strictly prohibited. Unauthorized use may subject violators to civil and criminal penalties.*

DOROT STAFF read this as part of the registration by phone and VERBAL AGREEMENT was received.
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.
Please verify that you are human*
For questions - infowestchester@dorotusa.org or (914) 485-8354

Last Updated 12/2025
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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: