AYES H.G. HILL ENROLLMENT FORM 2023-2024

Fall Semester: September 5, 2023 to December 7, 2023 Spring Semester: January 8, 2024 to May 3, 2024

The Nashville After Zone Alliance, or NAZA, is a city-wide out-of-school time partnership between Nashville Public Library, MNPS, Mayor's Office and non-profit providers working together and committed to high quality afterschool programming especially for middle school youth.

NAZA-funded programs are offered free of charge to youth and parents. Programs cannot offer a "drop-in option." Parents and youth must commit to regular attendance for at least one semester. Below are NAZA-funded program choices at your child's school for the 2023-2024 school year (youth admitted into a NAZA-funded program in the fall will have the option of continuing into the second semester Youth are accepted on a First Come, First Served Basis.

"Aspiring Youth Enrichment Services"

The AYES After-School Program is full of fun and interactive ways for youth to learn Science, Technology, Engineering, Art,

and Math. AYES uses a holistic approach to bridge the gap between school and the real world. The AYES After-School

Program provides many opportunities for youth and their families to enjoy learning financial literacy, social and emotional

well-being, agriculture, STEAM, and other life-skills.

Transportation: Transportation Provided

Student Record Release Permission

Nashville After Zone Alliance (NAZA) partner agencies receive information from Metro Nashville Public Schools (MNPS) about the students that are enrolled in AYES or affiliated programs. The programs utilize personally identifiable information (PII) from students' school records to plan and provide high-quality after-school programming for your student. Information that is deemed as part of the student's school record is listed below:

• School ID
• School name
• Student number
• Last name
• First name
• Middle name
• Preferred name
• Birthdate
• Gender
• Grade level
• Address
• Phone number

IEP Status (Presence of an IEP, and dates that indicate if a new IEP is due) Note: MNPS will not share any additional information about your child's IEP. The parent/guardian is the only person(s) allowed to disclose any additional information about the IEP.

• Daily Attendance record
• Number of suspensions (in and out of school)
• Academic achievement data, such as:
• State summative assessment/TCAP(if administered)
• Interim benchmark assessment/MAP
• College and career readiness assessments
• WIDA ACCESS for English Learners
• Class grades Access to devices (computer, tablet) and internet at home

The information will be treated as confidential in agreement with the Family Educational Rights and Privacy Act (FERPA), will not be released to any other parties that are neither associated nor affiliated with NAZA, and will be used for the sole purposes to continue providing high quality after school programming to your child. NAZA personnel and its partners will be properly trained to protect your student's Personally Identifiable Information (PII Any PII that has been collected and maintained by NAZA partner agencies (AYES) will be permanently destroyed at the end of the academic year.

I give my permission to the Nashville After Zone Alliance and AYES, unless otherwise noted in the space below:

a.To have my child participate in NAZA-funded programs and activities at my child's school as well as other off-site locations throughout the NAZA system, as specified in this enrollment form, knowing that this might include special activities, such as off-site events, end-of-year celebrations, homework/academic help, and field trips, and realizing that some of these may take place outside of regular program hours.

b. With the medical information provided in the program application in mind, to engage in all activities except as noted.

c. To secure proper medical treatment for my child in the event of an emergency. If or my emergency contact cannot be reached, I give permission for a physician to order routine tests and treatment for the health of my child. I give permission to a physician to secure treatment and/or hospitalize my child; after all emergency contact attempts have been made.

d. To provide assistance in accessing devices and internet services when presented as a barrier for my child to participate in afterschool and summer programs.

e. To use in media releases to benefit NAZA and AYES, photographs, creative work, quotes, videos, or other media which may include my child.

I, the undersigned, understand, acknowledge, and agree:

• That I have read and understand the information provided in the Parent Consent Form.
• That I will update any information I provided about my student in a timely fashion.
• That NAZA and AYES will request my child's records that may contain personal information (share demographics, grades, assessment, attendance, behavior/suspensions, IEPs and information about access to technology and internet at home) for the sole purpose of helping my child succeed in school and beyond.
• I therefore waive, with respect to these disclosures, any duty of confidentiality arising from Federal or State requirements.
• That participation in NAZA-funded programs and providing information about my child may involve certain risks. I assume all of these risks.
• That AYES will make themselves available to children, parents, and school staff and any concerns they might have.
• That AYES will protect the safety, interests, and rights of all individuals in the program. Therefore, each program will provide a parent/youth handbook or other program-specific information, including behavior policies and grievance procedures.
• That my child may be asked to complete surveys regarding the program for evaluation purposes.
• That I will not seek to hold NAZA or AYES responsible for any losses or damages whatsoever which I or my child may incur in connection with NAZA or AYES.
• That all program staff are employed by AYES, who are responsible for the operations of the program and supervision of their personnel. NAZA takes no responsibility for these operations or supervision.                                                                                                                                                         I, the parent or legal guardian, give consent for Metro Nashville Public Schools to share my child's information, as described above, with NAZA staff and AYES for the purpose of planning and providing high-quality afterschool programming to my child. fully release and discharge MNPS and its employees from any and all liabilities arising out of or in connection with the above-described data sharing relative to NAZA and AYES. I reserve the right to withdraw my consent at any time by submitting a written notice of withdrawal of consent to NAZA or AYES.