Date of Birth: 
Wednesday, 24 July, 0047
Other information: 
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Gender: 
Boy
School: 
62
Emergency Contact: 
73
Emergency Contact Phone Number: 
56
Parent / Guardian: 
Kristy
85
50
62
Relationship of Emergency Contact to the Child: 
48
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: 
Sayra