Date of Birth: 
Sunday, 18 April, 0010
Other information: 
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Gender: 
Boy
School: 
44
Emergency Contact: 
39
Emergency Contact Phone Number: 
24
Parent / Guardian: 
Nikki
62
49
87
Relationship of Emergency Contact to the Child: 
49
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: 
Earnestine