More Information - Fill Out Information Below : Colville Valley Junior Academy Colville WA

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More Information - Fill Out Information Below

Primary Contact

Cell Number

Secondary Contact

Cell Number

Home Information

Phone Number

Notes/Instructions

Primary Contact Relationship

Secondary Contact Relationship

Student Legal First Name

Student Legal Middle Name

Student Legal Last Name

Student Legal Full Name

Student Email Address

Student Gender

Student Birthdate

Student - US Citizen

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Student - Race/Ethnicity

Student Birth Country

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