Date of Birth: 
Tuesday, 16 April, 0024
Other information: 
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Gender: 
Boy
School: 
11
Emergency Contact: 
48
Emergency Contact Phone Number: 
18
Parent / Guardian: 
Jayme
89
54
21
Relationship of Emergency Contact to the Child: 
12
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: 
Frederica