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Student First Name
Student Last Name
Parent Email Address
Parent First and Last Name
Student Date of Birth
Emergency Contact: Name, Relationship, and Phone Number
What church are you affiliated with?
Grace Baptist Church of Lewisberry
Horizon Christian Fellowship (OH)
New Love in Christ Church (PA)
Christ Baptist Church (KY)
If other please list below...
Who invited you to Avalanche 22?
Register My Student
Feb 18, 4:00 PM – Feb 20, 11:00 AM