2023 VBS REGISTRATION FORM

Please join us for VBS at Westbrooke Church June 19-23, 2023 from 9-11:45 am daily and a FREE Fun & Games Themed Picnic for all ages starting at 6 pm on June 23.

VBS is open to children ages 4-6th grade (2023-2024 school year).

Participant #1

First Name

Last Name

Date of Birth

Gender

Male Female

Grade (for '22-'23 school year)

K 1 2 3 4 5 6

Snack/Alleriges

My child has NO allergies My child has allergies (list below)

Please list any allergies:

Participant #2

First Name

Last Name

Date of Birth

Gender Male Female

Grade (for '22-'23 school year) K 1 2 3 4 5 6

Snack/Allergies My child has no allergies My child has allergies (list below)

Please list any allergies here:

Participant #3

First Name

Last Name

Date of Birth

Gender Male Female

Grade (for '22-'23 school year) K 1 2 3 4 5 6

Snack/Allergies My child has NO allergies My child has allergies (list below)

Please list any allergies here:

Participant #4

First Name

Last Name

Date of Birth

Gender Male Female

Grade (for '22-'23 school year) K 1 2 3 4 5 6

Snack/Allergies My child has NO allergies My child has allergies (list below)

Please list any allergies here:

Participant #5

First Name

Last Name

Date of Birth

Gender Male Female

Grade (for '22-'23 school year) K 1 2 3 4 5 6

Snack/Allergies My child has NO allergies My child has allergies (list below)

Please list any allergies here:

Guardian Information

Name (first and last)

This address will receive a confirmation email

Phone

Address

Name of Church you regularly attend (if you have one):

Authorized Pickup Persons

Name of Person #1

Phone

Name of Person #2 (if there is only 1 person who will pick up your child, please enter that same name and phone number again here)

Phone

Photo/Video Waiver

I give permission to Westbrooke Church to photograph, video or make audio recordings of my child/children to the classroom, playground, auditorium activities and productions. This consent is given with the knowledge that these might appear in the media or be used in conjunction with exhibits, publicity and public relations.

Yes No

Please list any other comments or information we need to know:

Suggested Donation

Suggested Donation is $10 per child. If would like to contribute, please mail or drop off your donations. Checks can be made payable to Westbrooke Church with "VBS" written in the memo line. Thank you!

Westbrooke Church
9777 Antioch
Overland Park, KS 66212

913-888-4750

2023 VBS REGISTRATION FORM

Description

Please Fix the Following