I understand that the Student Participant has been selected to participate in the Philadelphia Music Alliance for Youth Artists’ Initiative (“PMAY Artists’ Initiative”) in connection with a grant from the Andrew W. Mellon Foundation (“Mellon Foundation”). Presently, the organizations that are participating in the PMAY Artists’ Initiative include: Musicopia; Philadelphia Orchestra; Philadephia Sinfonia; Philadelphia Youth Orchestra; Play On, Philly!; Project 440; Primavera Fund; School District of Philadelphia Office of Music Education; Settlement Music School; and Temple University Music Preparatory Division of the Boyer College of Music & Dance (“Participating Organizations”).
Student Participant Information
I hereby give my consent and permission to Settlement Music School, its agents, attorneys, representatives, and employees (“SMS”) to collect, store, release to, and/or share with any of the Participating Organizations, information pertaining to the Student Participant as part of her/his participation in the PMAY Artists’ Initiative. This information may include:
1) Full name;
2) Parent or guardian’s name;
3) Contact information;
4) Instrument played;
5) Advocating organization;
6) Race and/or ethnicity;
7) Grade school attended;
8) Grade level;
9) Age and birth date;
10) Summer activities;
11) Aspects of Personalized Learning Plans (PLPs);
12) Dates of and notes from Student Advocate check-ins with student;
13) Dates of and notes from Teacher check-ins with student;
14) Links to online recordings and/or videos of the student’s auditions, performances, and/or recitals;
15) Memberships in music classes, groups and/or organizations; and
16) Other information determined to be related to a student’s participation in the PMAY Artists’ Initiative.
I agree to release SMS from any claims and rights arising under FERPA, HIPAA, the Individuals with Disabilities Education Improvement Act of 2004, 20 U.S.C. Sections 1400-1485 (“IDEA 2004”) and its implementing regulations, 34 C.F.R. Part 300 et. seq.; Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. Section 794, and its implementing regulations, 34 C.F.R. Part 104 et. seq.; the Americans with Disabilities Act of 1990, 42 U.S.C. Section 12101-12213 and any implementing regulations; Sections 1983 and 1988 of the Civil Rights Act, 42 U.S.C. Sections 1983, 1988 and any implementing regulations; Chapters 15 of the regulations of the State Board of Education, 22 Pa. Code Chapters 15; Chapter 342 of the standards of the Pennsylvania Department of Education, 22 Pa. Code Chapter 342; Chapter 14 of the regulations of the State Board of Education, 22 Pa. Code Chapter 14; the Pennsylvania Human Relations Act; The Pennsylvania Public School Code of 1949, 24 P.S. §§ 1-101 et. seq.; The Pennsylvania Code; The Pennsylvania Constitution, The United States Constitution and any other state or federal law or regulations, including but not limited generally to any claim which is, was or could be brought under the statutes and regulations above recited and specifically to any claims, including attorney’s fees, costs or damages.
I also understand the following:
Identifying information about a Student Participant may be shared with and released to Participating Organizations to the extent necessary to develop and/or implement the objectives of the PMAY Artists’ Initiative.
Components of a Student Participant’s Individualized Education Plan (IEP) and/or disability accommodations may be referenced insofar as that information is considered germane to the Student Participant’s participation in the PMAY Artists’ Initiative.
Student Participant Information may be shared with the Mellon Foundation as part of reports, recordings, and analyses about the PMAY Artists’ Initiative.
Photographs and Recordings of Student Participant
I also give my consent and permission to SMS take photographs, audio recordings, video recordings, and/or other digital images or recordings (“Photos and Recordings”) of Student Participant during auditions, performances, and/or at other events in connection with the PMAY Artists’ Initiative and to use, edit, alter, copy, publish, and/or distribute those Photos and Recordings in any and all publications, including social media and web-based publications, and/or for any other lawful purpose, without payment, compensation, royalties, or other consideration. I further understand and agree that all Photos and Recordings will become the property of SMS and will not be returned.
This consent and release shall remain valid for the duration of the student's involvement in the program unless withdrawn in writing by me and/or another parent or guardian acting on behalf of the Student Participant.