GPA PMA Enrollment Form (2026-2027)

GPA PMA Enrollment Form (2026-2027)
Welcome to GPA PMA at The Enrichment Center of Long Island!

This form is the next step in the enrollment process for the 2026–2027 program year. It allows us to learn more about your family, your student(s), and how we can best support your homeschool journey.

Please complete all sections carefully. Submission of this form does not guarantee placement, as all enrollments are subject to review and availability.

We look forward to partnering with your family.
Family Information
Parent/Guardian 1 Full Name

First NameLast Name
Parent/Guardian 1 Email Address
example@example.com
Parent/Guardian 1 Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian 2 Full Name

First NameLast Name
Parent/Guardian 2 Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian 2 Email Address
example@example.com
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Preferred Method of Communication
How many Children are you enrolling?
Student 1 Information
Student 1 Full Name

First NameLast Name
Student 1 Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Student Age
Student 1 Grade Level (2026–2027 School Year)
Student 1 Program of Interest
Student 1 Medical Conditions
If yes, please describe Student 1's medical conditions
Student 1 Allergies
If yes, please list Student 1's allergies and severity
Does this student require an EpiPen?
Does this student have an IEP or 504 Plan?
If yes, please provide relevant details for Student 1
Is there anything else you would like us to know to best support Student 1?
Student 2 Information
Student 2 Full Name

First NameLast Name
Student 2 Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Student 2 Age
Student 2 Grade Level (2026–2027 School Year)
Student 2 Program of Interest
Student 2 Medical Conditions
If yes, please describe Student 2's medical conditions
Student 2 Allergies
If yes, please list Student 2's allergies and severity
Does this student require an EpiPen?
Does this student have an IEP or 504 Plan?
If yes, please provide relevant details for Student 2
Is there anything else you would like us to know to best support Student 2?
Student 3 Information
Student 3 Full Name

First NameLast Name
Student 3 Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Student 3 Age
Student 3 Grade Level (2026–2027 School Year)
Student 3 Program of Interest
Student 3 Medical Conditions
If yes, please describe Student 3's medical conditions
Student 3 Allergies
If yes, please list Student 3's allergies and severity
Does this student require an EpiPen?
Does this student have an IEP or 504 Plan?
If yes, please provide relevant details for Student 3
Is there anything else you would like us to know to best support Student 3?
Emergency Contact Information
Emergency Contact 1 Name

First NameLast Name
Emergency Contact 1 Relationship to Student(s)
Emergency Contact 1 Phone
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact 2 Name

First NameLast Name
Emergency Contact 2 Relationship to Student(s)
Emergency Contact 2 Phone
Please enter a valid phone number.Format: (000) 000-0000.
Dismissal Authorization & Procedures
Students are dismissed from the GPA PMA facility, located at St. Ignatius Loyola, 129 Broadway, Hicksville, NY 11801, at designated times based on the program schedule.

Parents/guardians are responsible for reviewing and adhering to dismissal times as communicated through the GPA calendar, Remind and BAND Apps, and email.

Arrival (Drop-Off)
Students may be dropped off beginning at 9:05 AM.
All students should arrive promptly to ensure a smooth start to the day.

Dismissal
Students dismissal times are as follows:

Pre-k/K: 1:45pm

1st and 2nd Grades: 2:00pm

3rd grade and up: 2:15pm
Pick-Up Authorization
Students will only be released to:
- A parent/guardian
- Individuals authorized by the parent/guardian.
Changes to Pick-Up
If a change to dismissal arrangements is needed:

The parent/guardian must notify the GPA front desk in advance
In the event of an unexpected change, the parent/guardian must notify GPA as soon as possible.
Authorized Pick-Up List: Please list all individuals authorized to pick up your child(ren):
Check below if your emergency contacts are allowed to pick up your child(ren).
Acknowledgement & Responsibility

By signing below, I acknowledge that:
- I understand GPA PMA arrival and dismissal procedures
- I am responsible for ensuring accurate and up-to-date pick-up information
- I understand that GPA staff and volunteers will follow the authorized pick-up information provided
- I agree to indemnify and hold harmless GPA PMA, its staff, volunteers, and affiliates from any liability arising from my child’s dismissal in accordance with the instructions provided.
Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Photo & Media Consent
At GPA PMA, we love celebrating the everyday moments that make our community so special. For more than seven years, we have shared photos and short videos from our classrooms, field trips, moving up ceremonies, and other events in our yearbook, newsletters, around our building, and during open houses.

We also use the Band app for classroom communication, where teachers may share photos and updates with families in their class. These images help capture the joy, learning, and friendships that are at the heart of GPA PMA, and allow us to share that spirit with our families—past, present, and future.

By indicating your preference below, you help us plan ahead—especially for first-day photos and special events.
Please select your preference regarding the use of your child(ren)’s photos and/or videos
Volunteer Commitment
GPA PMA is a community-based program, and family participation plays an important role in keeping our program running smoothly and safely. Each family is expected to contribute in some capacity throughout the year. For safety and daily operations, hall monitoring is especially encouraged and prioritized.
How would your family like to fulfill your volunteer commitment?
Hall Monitor Availability
Are you available to assist during program hours?
Preferred Days (which days are you most available?)
Tuition & Payment
See Full Tuition & Payment Policies in the GPA Agreement

Tuition for GPA PMA is based on an annual program fee, which is divided into equal monthly payments for convenience.

Monthly payments are not based on the number of days attended in a given month, but rather represent a portion of the total annual tuition.

As a result, some months may have more or fewer scheduled program days due to holidays, calendar variations, or program scheduling. Tuition remains consistent regardless of the number of days in any given month.

Payment Schedule

Tuition is due on the 1st of each month and must be received no later than the 5th. A $50 late fee will be applied to payments received after the 5th.

Payments are due on the following dates:

September 1, 2026
October 1, 2026
November 1, 2026
December 1, 2026
January 1, 2027
February 1, 2027
March 1, 2027
April 1, 2027
May 1, 2027
June 1, 2027

Failure to maintain timely payments may result in revocation of enrollment.

Payments are submitted via Zelle to:
516-835-9817 or davidmachson1@gmail.com

If a financial hardship arises, families should contact:
GPAFamilies123@gmail.com

Program Term & Withdrawal

The GPA PMA program runs from September 2026 through June 2027.

A 60-day written notice is required to withdraw from the program. Notice must be submitted on the first of a given month, and tuition remains due during the notice period.

Any prepaid month will be applied to the final 30 days of enrollment.

Financial Responsibility

Enrollment is contingent upon maintaining a current and active account.

By enrolling, I acknowledge responsibility for all tuition payments and agree to adhere to GPA PMA financial policies.
Initials
Parent Membership Agreement

The following agreement outlines the financial and participation policies for GPA PMA. Please review carefully before signing.
GPA operates as a private membership association. By enrolling, you are choosing to participate as a private member rather than as a public school customer.
- Membership is voluntary
- GPA operates in the private domain
- Membership may be revoked if behavior is harmful to the community
- Disputes are handled internally within the association
By joining GPA PMA, a Private Membership Association (herein defined as the “Association”), and/or any Facebook Group or other social media group organized by the Association, I agree to the following:

This Association provides a platform for members to conduct private business and interact within the protections guaranteed by the Constitution of the United States of America and the Charter of Rights of Canada. These protections include freedom of speech, assembly, and the right to gather for lawful purposes.

Members have the right to:
- Seek and receive advice, guidance, and support from other members
- Choose educational and enrichment opportunities that best suit their children.
- Participate in a private, member-based educational community.
The Association recognizes all members who agree to its principles and policies and who have not been sanctioned or removed by leadership.

Membership may be terminated at any time by Association leadership if a member is not acting in alignment with the values and expectations of the community.

I understand that the Association operates in the private domain and that complaints or grievances will be handled internally by an Association-designated process.

I am joining voluntarily, without coercion, and affirm that I am not acting on behalf of any regulatory or government agency.

I understand that I may withdraw at any time and that my membership may be revoked if I engage in abusive, threatening, or harmful behavior.

See Full GPA Agreement and membership terms here.
Initials
Legal Agreement & Indemnification
The undersigned parent/guardian agrees to indemnify, defend, and hold harmless GPA PMA at The Enrichment Center of Long Island, David Machson, Ramona Machson, Rental Facility named “St. Ignatius Loyola” located at 129 Broadway Ave, Hicksville, NY 11801, and all directors, officers, staff members, instructors, volunteers, and affiliates from and against any and all claims, liabilities, damages, losses, or expenses (including reasonable attorneys’ fees) arising out of or related to:

(a) the child’s participation in the program,
(b) any allergic reaction or medical incident, including those related to food exposure, and
(c) any failure by the parent/guardian or child to adhere to program policies.

The parent/guardian acknowledges that while reasonable precautions are taken, a completely allergen-free environment cannot be guaranteed.

View the full PMA legal terms and indemnification and liability policies here.
Initials
Agreement & Signature
📄 Please scroll through the agreement below before continuing
Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Thank you for taking the time to complete this enrollment form.

We are grateful for your interest in GPA PMA and look forward to partnering with your family for the 2026–2027 program year.

Once your submission has been reviewed, a member of our team will follow up with next steps regarding enrollment.
Should be Empty:

GPA PMA Enrollment Form (2026-2027)

Family Information

Student 1 Information

Student 2 Information

Student 3 Information

Emergency Contact Information

Dismissal Authorization & Procedures

Photo & Media Consent

Volunteer Commitment

Hall Monitor Availability

Tuition & Payment

Parent Membership Agreement

Legal Agreement & Indemnification

Agreement & Signature