Breakthrough Cincinnati Student Paperwork

We are happy to have your family as a part of the Breakthrough Cincinnati community. Each summer we aim to provide the safest and best possible experience for each participant, it is important that we collect a variety of information and secure your permission for various activities.

Please follow the navigation in this form to complete all sections relevant to your participant. You will complete a separate form for each participant if you have multiple participants in the program. 

There are items that ALL participants will need to complete and some items that are only requested for CERTAIN participants. Breakthrough also works with outside community partners who seek external permissions. See below for an overview of what we are seeking. 

You will receive an email with record of your responses to this form.

There are four sections to this form.
  1. Participant Information (Should pre-populate from your application/update form).
  2. Contract, Policies & Permissions needed to participate in BTC.
  3. Health related information to keep your participant safe while at BTC.
  4. Releases/authorizations of BTC to be the best steward while a participant of BTC.
Breakthrough Cincinnati maintains confidentiality with all the information you provide. 
If you have any questions about this form, please reach out to btcprogram@breakthroughcincinnati.org
Filling out Program Paperwork
  • This form should take up to 15 minutes. You will need to complete it in one sitting.
  • Please have your Health Insurance or Physician's Information available.
  • Please have your Ohio benefits WIC #, SNAP # (Food Assistance) or OWF # (Ohio Works First) available. 
  • Some participants may need to fill out additional forms based on their needs. BTC will link you to a landing page with access to the forms you need to complete. 
  • The Program Paperwork needs to be completed before May 15 to support program planning. The participant may not be able to be fully active until all paperwork is complete.
  • Once you have filled in all the fields in this form, you will be sent an email to verify your signature. 
  • Please verify your signature in a timely manner. This will activate your copy of your responses (.pdf and/or email).

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