Date of Birth: 
Tuesday, 8 February, 0078
Other information: 
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Gender: 
Boy
School: 
18
Emergency Contact: 
28
Emergency Contact Phone Number: 
10
Parent / Guardian: 
Neha
76
86
53
Relationship of Emergency Contact to the Child: 
55
School Year: 
12
I agree that my child may receive emergency medical treatment by a trained member of staff or medical practitioner if needed: 
Doctor Address: 
Seleste