Encounter-Disciple Now
Date: Jan 21-123, 2022
Cost: $40

Faith, Friends, and Fellowship
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Student's Name (First and Last) *
Gender *
Current Grade *
T-Shirt Size *
Parent's Name(s) (First and Last) *
Parent's Number *
Parent's Email (This is where I will send a what to bring list as well as the itinerary) *
Student's Number
Student's Favorite Movie
Dietary restrictions *
Fun Fact about Student:
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