Date of Birth: 
Sunday, 15 June, 0092
Other information: 
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Gender: 
Boy
School: 
70
Emergency Contact: 
46
Emergency Contact Phone Number: 
77
Parent / Guardian: 
Dora
16
49
28
Relationship of Emergency Contact to the Child: 
45
School Year: 
13
I agree that my child may receive emergency medical treatment by a trained member of staff or medical practitioner if needed: 
Doctor Address: 
Noelia