Date of Birth: 
Friday, 29 August, 0014
Other information: 
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Gender: 
Boy
School: 
35
Emergency Contact: 
23
Emergency Contact Phone Number: 
73
Parent / Guardian: 
Berlin
50
98
28
Relationship of Emergency Contact to the Child: 
88
School Year: 
10
I agree that my child may receive emergency medical treatment by a trained member of staff or medical practitioner if needed: 
Doctor Address: 
Marianna