Goodlettsville PNA - 2026-2027 Registration

Goodlettsville PNA 2026-27 Registration Form

Eligibility: Children currently enrolled at Goodlettsville Elementary School
I have read and understand the enrollment and program policies*

Clear
Fees & Enrollment
- A nonrefundable registration fee of $100 is assessed and due with this application. Enrollment slots will be confirmed and held only upon receipt of the registration fee.
- Students with a balance due for the previous year will not be allowed to register until their balance is paid in full.
- The annual program fee for Goodlettsville PNA is payable monthly across ten installments of $225. Payments are due on the first day of each month and are charged equally across ten months from August to May. Recurring payments by ACH or credit/debit card are required. Following submission of this application, a payment schedule will be sent by email for setting up recurring payments.
- Fees are assessed based on the cost of providing services to your child for the entire school year. There is no credit given for absences or for school closures (due to holidays, inclement weather, etc.). Fees are not pro-rated since they are based upon the entire school year. They are simply payable on a monthly basis for your convenience.
- Students with accounts over 14 days past due will not be allowed to attend until the account is paid current. A late fee of $50 will be assessed if payment is not received by the 7th day of the month.
- Children are accepted on a first-paid, first-served basis. If the program has reached its capacity, your child will be placed on a Waiting List in the order that enrollment forms are received. Registration fees must be paid in full before a child from the waiting list will be admitted into the program.
- Children will not be enrolled in the program unless and until all forms have been completed and submitted.
Program Policies
- The program is open according to the official, in-person learning school calendar of Metro Nashville Public Schools, and is closed during breaks/holidays, inclement weather and half-days. If there is not a full day of school, there is no program. Early care is not provided on days in which school opens late.
- Your child will be under the supervision of the PNA staff, from the time he or she arrives at the site, until your child leaves the site, according to your written instructions for departure. Program staff must be notified, in writing, of any changes in the program departure procedures. No child will be released to a person who is not listed on the registration form or to anyone whose behavior may place the child at immediate risk.
- In order to secure their continuing enrollment, children are required to attend the program on a regular basis. It is requested that parents notify the program about long-term absences. Children who do not attend regularly will be at risk of removal from the program.
- Removal or suspension from our program may occur if the following inappropriate behavior is used: stealing; damaging property; using foul language; being disruptive and uncontrollable in the group; harming another student or staff person; inappropriate behavior(s) not solved after repeated attempts; behavior detrimental to the student and/or others. Staff will communicate regularly with families regarding behavior concerns. Every effort will be made by staff to enlist the cooperation of the student and parents to solve problems. Student must be able to function in a learning environment designed with a 15:1 student/teacher ratio. If a student’s behavior is problematic, the parent will be notified and appropriate action will be taken, which may result in removal of the student from the program. Metro Nashville Public School Code Page 2 of 6 of Student Conduct, including zero tolerance violations, will be enforced.
- Parents/guardians are responsible for the repair and/or replacement of program and school materials that are damaged or destroyed by their child.
- All children must be picked up by close of the program day. $1/minute late fee is charged after the end of the program day. A child will be removed from the program if he or she is consistently picked up late.
- Grievances: Parent input concerning the program is important. Feel free to share these comments with the Site Director. If you are unable to resolve questions concerning policies and procedures, you may contact Executive Director Illia Moore at 615.385.7067 (ext. 1).
- Nondiscrimination Notice: It is the policy of PNA not to discriminate on the basis of sex, race, national origin, creed, age, marital status or disability in its programs, activities, or employment policies as required by Title VI and Title VII of the 1964 Civil Rights Acts, Title IX of the 1972 Educational Amendments and Section 504 of the Federal Rehabilitation Act of 1973. Should you have a complaint related to perceived discrimination, contact Executive Director Illia Moore at 615.385.7067 (ext. 1).
Full name*

First nameLast name

Student Support & Safety
Project for Neighborhood Aftercare (PNA) is committed to providing a safe, supportive, and inclusive environment for all students and does not discriminate based on disability. Afterschool programs operate differently from regular school hours and may not offer the same staffing, services, or individualized support during instructional time.

PNA operates as a group-based program with a typical staff-to-student ratio of about 1:15, where staff supervise multiple students simultaneously. While we collaborate with families and consider reasonable supports within our program structure, the program is not intended to provide continuous one-on-one supervision or personal care services.

If a student’s needs require supervision beyond our staffing capacity or if behaviors pose a significant safety risk to the student, other participants, or staff, PNA may review the situation with families to determine appropriate next steps to maintain a safe environment for everyone.
How Parents Can Help
To help our staff support your child successfully in a group setting, please share information that will help us understand how your child participates in activities.

You are not required to disclose medical diagnoses, IEPs, or 504 plans. We are only seeking information that helps staff plan appropriate supports within our group-based program structure.

Helpful information may include:

• How your child handles transitions between activities
• Situations that may cause frustration or stress
• Strategies that help your child stay focused or calm
• Supports that help your child succeed in group settings
Functional Needs & Safety Checklist

Please indicate whether your child currently experiences any of the following:
YesNo
YesNo
YesNo
YesNo
If you answered Yes to any item above, please briefly describe the situation and strategies that help your child succeed (for example: movement breaks, quiet space, redirection, visual reminders).
Safety & Supervision Expectations
Students must stay within assigned program areas and be supervised by staff at all times.

If a student leaves a supervised area or exhibits behaviors that pose a safety risk, staff will respond immediately and notify parents or guardians.

PNA may take progressive steps to address unsafe behaviors, including:

• Staff redirection and support strategies
• Parent/guardian communication
• Parent conference to discuss strategies
• Development of a support plan when feasible

If, after reasonable efforts to support the student, behaviors continue to pose a significant safety risk or require supervision beyond the program's capacity, temporary suspension or removal from the program may occur.

PNA values strong partnerships with families and believes that open communication helps create the best experience for every child. The information shared in this section enables our staff to plan effectively, support student success, and maintain a safe environment for all participants. If additional information is needed, a member of our team may contact you to discuss how we can best support your child within our program structure.

Parent / Guardian Information
Parent / Guardian Name (primary contact)*

First nameLast name
Parent / Guardian Name (secondary contact)

First nameLast name
Cell phone*
Format: (000) 000-0000.
Email address*
example@example.com
Home phone
Format: (000) 000-0000.
Home address*

Street address

Street address line 2

CityState / Province

Postal / Zip code
Employer
Work phone
Format: (000) 000-0000.

Child Safety - Release Authorization

For child’s safety, list all persons to whom child may be released,
Person 1
Full name*

First nameLast name
Phone #*
Format: (000) 000-0000.
YesNo
Person 2
Full name*

First nameLast name
Phone #*
Format: (000) 000-0000.
YesNo
Person 3
Full name*

First nameLast name
Phone #*
Format: (000) 000-0000.
YesNo
Person 4
Full name*

First nameLast name
Phone #*
Format: (000) 000-0000.
YesNo
Person 5
Full name*

First nameLast name
Phone #*
Format: (000) 000-0000.

Emergency Information

Do Not Leave Blank
Name of person, other than parent / guardian, authorized to act for the parent in an emergency:
Full name*

First nameLast name
Relationship*
Cell / Home phone*
Format: (000) 000-0000.
Employer
Work / Office phone
Format: (000) 000-0000.
Name of child’s physician*
Physician's phone #*
Format: (000) 000-0000.

Goodlettsville PNA 2026-27 Registration Form

Program Policies

Permissions & Statements of Understanding

Student Support & Safety

How Parents Can Help

Functional Needs & Safety Checklist

Safety & Supervision Expectations

Child / Student's Information

Second Child / Student's Information

Third Child / Student's Information

Parent / Guardian Information

Child Safety - Release Authorization

Person 1

Person 2

Person 3

Person 4

Person 5

Emergency Information

Medical

Medication 1

Medication 1