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AWANA & Youth180
2024 REGistration
Child's First Name
*
Child's Last Name
*
Child's Birthday (age)
*
Grade In Fall '24
*
Any Allergies?
*
Parent/Guardian Full Name
*
Parent/Guardian Email
*
Parent/Guardian Phone #
*
Street Address
*
City & State
*
Zip Code
*
Submit
CityLight Baptist Church
1121 Sperryville Pike
Culpeper, VA 22701
540.321.4400
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