Western Springs Baptist Church | the Village Church
4475 Wold RD. Western Springs, IL 60558
Contact us at (708) 246-1530 or wsbc@wsbc.info
Date: June 10-14, 2019
Time: Monday-Friday 8:45 AM - 12:15 PM
Registration Fee is $25/Child (includes Shirt & Music CD).
Please fill out this form completely (up to 4 children) and click the "Submit" Button to finalize your registration at the end of this form on page 5.

You will have 2 Payment options after you have clicked the "Submit" Button on this form:
--> Option 1: Pay with Check or Cash at WSBC Office. Please, make checks payable to Western Springs Baptist Church.
--> Option 2: Pay online. Follow the link on the confirmation page after you have Clicked the "Submit" Button.

Parent First Name *
Your answer
Parent Last Name *
Your answer
Email *
Your answer
Main Phone (mobile preferred) *
Your answer
Emergency Contact Name *
Your answer
Emergency Phone (mobile preferred) *
Your answer
Home Address (street) *
Your answer
Home Address (city) *
Your answer
Home Address (state) *
Your answer
Home Address (zip) *
Your answer
Does your Family regularly attend a Church? If YES, then which church?
Your answer
Child Registration
You may register up to 4 children on this form. If you are only registering fewer than 4 children, then please click the "Next" buttons at the bottom of each page to get to the "Submit" button at the end of the Form on page 5.
Thank you.
Total Number of Children you are Registering today. *
Photo Permission & Release Waiver
I hereby grant the Village Church | Western Springs Baptist Church permission to use my child(ren)’s likeness in a photograph in any and all of its publications, including website entries, without payment or any other consideration. I hereby authorize the Village Church | Western Springs Baptist Church to edit, alter, copy, exhibit, publish or distribute this photo for purposes of publicizing the Village Church | Western Springs Baptist Church programs or for any other lawful purpose. In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein the likeness appears. I waive any right to royalties or other compensation arising or related to the use of the photograph. I hereby hold harmless and release and forever discharge the Village Church | Western Springs Baptist Church from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.
I have read and agree to the Photo Permission & Release Waiver. *
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