By signing this Participation Agreement, I agree to the following:

I (and/or my minor child/children) volunteer willingly to participate in the 2025 Prima Music Institute & Festival Piano Camp in Pittsfield, MA.

I (and/or my minor child/children) will only participate in activities that sadly meet skill and ability levels.

I understand that Prima Music Institue & Festival Piano Camp does not provide health insurance for me (and/or my child/children)

I understand that a staff member will attempt to contact to parent, guardian, or emergency contact listed on the "Consent to Treat Minor Children" form in case of illness or injury. I authorize these representatives to contact paramedics and/or take me/my child to a hospital and be given treatment by paramedics and hospital staff as necessary.

I (and/or my minor child/children) are in good health and will inform Ms. Anastasia Dedik, the Prima Music Institute & Festival Piano Camp's Director of any health issues that may be of concern during the camp.

I (and/or my minor child/children) agree to be liable for any damages caused to the properties of 11 Fairwynds Dr., Lenox MA, 30 Wendell Ave, Pittsfield, MA or Miss Hall's School at 492 Holmes Rd, Pittsfield, MA.

Photographs or video/audio recordings may be taken of you and/or your child/children during the Prima Music Institute & Festival Piano Camp. Unless you request otherwise, the Participation Agreement will be considered permission of Prima Music Institute & Festival Piano Camp to photograph, film, audio/video tape, record and/or televise your image and/or voice or the image and/or voice of your child/children for use in any publications or promotional materials, in any medium now known or developed in the future without any restrictions. If you object to using your image or voice or your child's/children/s image or voice in this manner, please notify the Camp Director, Ms Anastasia Dedik, in writing, upon submission of this Agreement.

I hearty RELEASE FROM LIABILITY, WAIVE, DISCHARGE AND COVENANT NOT TO SUE Prima Music Institute & Festival Piano Camp and any of the officers, servants, agents and employees of the above-mentioned entities (hereinafter referred to as RELEASEES) for any liability, claim and/or cause of action arising out of or related to any loss, damage or injury, including death, that occurs as a result of participation in the specified activities. 

By signing this PARTICIPATION AGREEMENT, I state that I have read, understand, and agree to the conditions set forth herein and that I sign this form freely and voluntarily.

I do hereby consent to any medical care and the administration of anesthesia determined by a physician to be necessary for the welfare of my child while said child is under the care of Ms. Anastasia Dedik, Prima Music Institute & Festival Piano Camp Director and I am not reasonably available by telephone to give consent. This authorization is effective from June 29, 2025 to July 6, 2025.

Check Payment Information:

Please make one check payable to Prima Music Foundation (write student's name and PMIF 2025 on the memo line) and mail it to: 

Prima Music Foundation c/o Anastasia Dedik
875 W. 181st St. Apt. 1i, New York, NY 10033

Zelle at: PrimaMusicFoundation@gmail.com

Prima Music Foundation is a 501(c)(3) nonprofit — EIN: 87-3811303