Where Kids Have Fun!

Happyland Day Camp Online Registration
Please complete one per camper



This application is for my

First Child in CampSecond+ Child in Camp

Camper's First Name:
Camper's Middle Name:
Camper's Last Name:


Returning Camper:
 Yes
 No
If No, Referred by:


Camper Date of Birth (MM/DD/Year): 
Gender:  Male   Female


Camper Grade this coming Fall: 
Name of Camper's School:  

Parents Are:
Married
Separated
Divorced
Widowed
Other


Camper lives with:
 Mother & Father
 Mother Only
 Father Only
 Other (please explain) 


Father:
Name: 
Address: 
City: 
Zip: 
Occupation: 
Home Phone: 
Business Phone: 
Cell Phone: 
Pager: 
Father's Email: 
 Mother:
Name: 
Address: 
City: 
Zip: 
Occupation: 
Home Phone: 
Business Phone: 
Cell Phone: 
Pager: 
Mother's Email: 


Emergency Contact - Other than parent:
Name:     Relationship:  
Phone: 


Select Weeks

5 Day Program
 Week 1 (June 28 to July 2)
 Week 2 (July 5 - July 9)
 Week 3 (July 12 - July 16)***
 Week 4 (July 19 - July 23)
 Week 5 (July 26 - July 30)
 Week 6 (August 2 - August 6)***
 Week 7 (August 9 - August 13)
 Week 8 (August 16 - August 20)

*** If your child is in grade 3 or 4 these are considered adventure weeks and incurs a $50 extra charge per week.


3 Day Program Ages 3 1/2 to 5 only (Min. of 2 weeks)
 Week 1 (June 28 to July 2)
 Week 2 (July 5 - July 9)
 Week 3 (July 12 - July 16)
 Week 4 (July 19 - July 23)
 Week 5 (July 26 - July 30)
 Week 6 (August 2 - August 6)
 Week 7 (August 9 - August 13)
 Week 8 (August 16 - August 20)




Optional Extended Day Program : Select Days
Week 1 (June 28 to July 2)AMPM
Week 2 (July 5 - July 9)AMPM
Week 3 (July 12 - July 16)AMPM
Week 4 (July 19 - July 23)AMPM
Week 5 (July 26 - July 30)AMPM
Week 6 (August 2 - August 6)AMPM
Week 7 (August 9 - August 13)AMPM
Week 8 (August 16 - August 20)AMPM


Bus Information
Check Bus Stop Below - (Bus not available for extended day)
St. Benedicts Church (Eggertsville/Snyder Area)
Heim Elementary
Maple East Elementary
Transit Middle
Casey Middle School (There will be a maximum capacity at this stop. If reached, we will contact you for an alternate choice)
Drop Off
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