Date of Birth: 
Friday, 28 June, 0097
Other information: 
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Gender: 
Boy
School: 
75
Emergency Contact: 
16
Emergency Contact Phone Number: 
11
Parent / Guardian: 
Caylin
65
92
75
Relationship of Emergency Contact to the Child: 
44
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: 
Gerry