Date of Birth: 
Sunday, 12 September, 0066
Other information: 
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Gender: 
Boy
School: 
69
Emergency Contact: 
39
Emergency Contact Phone Number: 
74
Parent / Guardian: 
Coral
16
91
21
Relationship of Emergency Contact to the Child: 
20
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: 
Celestina