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LAKESIDE COUNTY PRIMARY SCHOOL
ADDRESS AND CONTACT DETAILS
Surname of child.............................................................................................Date of Birth.............................
Forenames..................................................................................................................................................................
Home Address..........................................................................................................................................................
.........................................................................................................................................................................................
Post Code................................................................................................................Tel No.......................................
Contact Number Home..........................................................................................................................................
Mobile Contact Numbers (if applicable)
Mother........................................................................................................................................................................
Father..........................................................................................................................................................................
Emergency Contact Name....................................................................................................................................
Emergency Contact Number...............................................................................................................................
Work Contact Numbers (If applicable)
Mother.........................................................................................................................................................................
Father..........................................................................................................................................................................
Signed................................................................................................(Parent/Carer)
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