Date of Birth: 
Thursday, 1 August, 0019
Other information: 
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Gender: 
Boy
School: 
35
Emergency Contact: 
92
Emergency Contact Phone Number: 
43
Parent / Guardian: 
Jewell
76
38
23
Relationship of Emergency Contact to the Child: 
95
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: 
Piper