Wild Wild West Sub
July 14-18 ~ 6:00 p.m. - 8:00 p.m.
Celebration Sunday, July 20th at 10 a.m.
Registration Form
For children entering K-8th Grade This Fall
Child's Information (one form per child)
Child's Name:
Date of Birth:
Parent/Guardian Name(s):
Address:
Home/Primary Phone:
Grade Entering Fall 2025:
Email Address:
IMPORTANT: Does your child have any allergies or medical conditions the staff should know about?
If yes, please specify, and list medications and dosage (otherwise enter "n/a"):
Emergency Contact Information
Contact Person #1:
Relation to child:
Home/Primary Phone:
Alt. Phone:
Contact Person #2:
Relation to child:
Home/Primary Phone:
Alt. Phone:
Permission to Transport
In the event of a medical emergency, we will call 911 for Emergency Services, including transport to the nearest hospital/clinic. Please provide the following information and check below to authorize emergency transport.
Child's Insurance Provider:
Policy #:
Parent or Guardian:
Date: July 22, 2026
Authority to Pick-Up/Dismiss
The following individuals are authorized to pick up my child from WSCC.
- (Mother/Guardian):
- (Father/Guardian):
- Name: Relationship:
- Name: Relationship:
My child has my permission to leave Kids' Club by him/herself (i.e. to walk home, bike home, etc.):
Parental Consent
I consent that my child, , is allowed to participate in West Suburban Community Church's Kids' Club program, and that my e-signature below acts as my legally binding signature.
Parent or Guardian:
Student Photographs
Photographs of students engaged in Kids’ Club 2025 activities may be taken and used for in-church purposes (bulletin boards, slide shows, etc.). Your child’s picture may also be posted on the church website or the church social media page. Your e-signature below acts as your consent.
