*
Required
Camper Information
Child's First Name:
*
required
Child's Last Name:
*
required
Nickname
Name child would prefer to be known as (if different from first name)
Birth Date
*
required
(mm/dd/yyyy)
Note: Camp at Odyssey is for current kindergartners through 6th graders.
Returning Student:*
Yes
No
Program:
*
required
Please Select…
Full Day
Half Day
Current School
*
required
Current Grade
*
required
Please Select…
K
1st
2nd
3rd
4th
5th
6th
T-shirt size
*
required
Please Select…
Youth XS
Youth S
Youth M
Youth L
Youth XL
Parent Information
Parent/Guardian #1:
*
required
Address
*
required
City
*
required
State
*
required
Please Select…
D.C.
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip Code
*
required
(ex. 06108 or 06108-0809)
Primary Phone Number
*
required
(###)###-####
Email
*
required
Parent/Guardian email
Add another parent?*
Would you like to add information for an additional parent or guardian?
Yes
No
Parent/Guardian #2:
*
required
Address
City
State
Please Select…
D.C.
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip Code
(ex. 06108 or 06108-0809)
Phone Number
*
required
(###)###-####
Email
Parent/Guardian email
Emergency Contact
*
required
In case of emergency, this person can be called.
Relationship to Camper
*
required
Emergency contact's relationship to camper
Emergency Contact Phone
*
required
(###)###-####
Address
*
required
City
*
required
State
*
required
Please Select…
D.C.
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip Code
*
required
(ex. 06108 or 06108-0809)
Health Information
Has your child had a psycho-educational assessment?
Yes
No
If yes, please upload
Max file size: 10 MB
Has your child had a speech and language assessment?
Yes
No
If yes, please upload
Max file size: 10 MB
Allergies:
*
required
If no allergies, type N/A
Allergy Description
Use this area to describe the allergies in more detail (hives, swelling, etc.)
Parent Questionnaire
Strengths:
*
required
How would you assess your child's major strengths?
Academic Needs:
*
required
How would you assess your child's greatest academic need(s)?
Outside Interests:
*
required
What outside interests does your child have?
Relationships:
*
required
Describe your child's relationships with peers and/or other family members:
How did you learn about us?
*
required
Please Select…
Current Odyssey Family
Post card
Friend or Family Member
Baltimore's Child
Baltimore Magazine
Child's Doctor
Social Media
Google
Other
If other, please describe:
Photo Permission*
May we use photographs of your child participating in Odyssey Summer Camp activities?
Yes
No
Please send a confirmation email to the address below*:
Please provide an email address where we can send a link to your current form.
Email Address :