Winter/Spring 2024 Intersession Lottery Form

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All families must complete this form for each of their children enrolled in Breakthrough Montessori.

Student First Name *

Student Last Name *

Parent/Guardian Name (first and last) *

Parent/Guardian E-mail Address *

Student Grade *

PK3

PK4

Kindergarten

Grade 1

Grade 2

Grade 3

Grade 4

Grade 5

Grade 6

Please select your student's enrollment status for the Intersession Program for January-June 2024. *

My child will remain at Breakthrough to nap from 1:15-3:15pm. This option is only available to PK3 students, as well as PK4 students who take a daily nap.

My child will participate in Intersession programming.

My child will not participate in Intersession programming or nap (if PK3). A caretaker will pick them up every Monday at 1:25pm.

Please Rank Intersession Programs from 1 (most preferred) to 12 (least preferred). Please rank all choice for which your student is eligible. For more information on these programs, please see www.breakthroughmontessori.org/intersession

Casa Lala (PK4-6)

The Lab Breakin' Academy (K-6)

Young Playwrights' Theater (3-6)

The Loft Collective (PK4-6)

The Nature Lab (PK4-6)

Discover Fun Camp (PK4-6)

Yoga Heights (PK4-6)

Urban Adventure Squad (3-6)

CREATE Arts Center (PK4-6)

Dance Exchange (3-6)

Kids and Culture Camp (PK2-2)

DC Self Defense Karate Association (2-6)

1st Choice (Most Preferred)

2nd Choice

3rd Choice

4th Choice

5th Choice

6th Choice

7th Choice

8th Choice

9th Choice

10th Choice

11th Choice

12th Choice (least preferred)

Casa Lala (PK4-6)

The Lab Breakin' Academy (K-6)

Young Playwrights' Theater (3-6)

The Loft Collective (PK4-6)

The Nature Lab (PK4-6)

Discover Fun Camp (PK4-6)

Yoga Heights (PK4-6)

Urban Adventure Squad (3-6)

CREATE Arts Center (PK4-6)

Dance Exchange (3-6)

Kids and Culture Camp (PK2-2)

DC Self Defense Karate Association (2-6)

1st Choice (Most Preferred)

2nd Choice

3rd Choice

4th Choice

5th Choice

6th Choice

7th Choice

8th Choice

9th Choice

10th Choice

11th Choice

12th Choice (least preferred)

Clear selection

Preference Eligibility: Please mark all statements below that pertain to this student.

My student is eligible for free and reduced price meals (FARM).

My student has a sibling participating in Intersession program, and our family prefers they be placed in the same program.

Does your student require aftercare (from 3:30pm onwards) following Intersession programming on Mondays? *

Yes

Please acknowledge your understanding of the following by checking each box. *

Unless my child is enrolled in Intersession or napping, I understand that a caregiver must pick them up each Monday at 1:25pm.

After receiving my program match, I will complete enrollment forms by December 19, 2023.

There is not a drop-in option for Intersession programs.

If my program takes place off campus, I understand that my child will commute from Breakthrough with their program partner to the program's location.

I will pick my child up directly from the program's location between 3:15-3:30pm (unless they are participating in aftercare).

If my family is not FARM eligible but requires financial assistance for Intersession, I will reach out to Emily Hedin at emily.hedin@breakthroughmontessori.org.

Required

If your student participated in Intersession from August-December 2023, please indicate which program they joined:

Yoga Heights

Dance Exchange

The Loft

Nature Lab

Casa Lala (PK4 group) - Takoma

Casa Lala (K-Grade 6 group) - Petworth

The Lab Breakin' Academy

Young Playwrights' Theater

Urban Adventure Squad

Discover Fun Camp

CREATE Arts

Clear selection

What has gone well with your experience with Intersession thus far?

What challenges have you experienced with Intersession?

Please share any specific feedback on Intersession, programming, communication, or logistics thus far.

Submit

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