Date of Birth: 
Monday, 15 May, 0073
Other information: 
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Gender: 
Boy
School: 
42
Emergency Contact: 
13
Emergency Contact Phone Number: 
61
Parent / Guardian: 
Paige
84
77
31
Relationship of Emergency Contact to the Child: 
49
School Year: 
11
I agree that my child may receive emergency medical treatment by a trained member of staff or medical practitioner if needed: 
Doctor Address: 
Kamora