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Please complete all fields marked (*)
As stated on birth certificate
If not already supplied please bring child's birth certificate for a copy to be taken
Child who is in the care of the local authority or social services - rather than living with biological parents
If different from legal surname
If yes please state name and year group
Walk / Car / Bus / Scooter/ Cycle
With whom the child lives with
Named on the birth certificate
Home / Mobile / Work
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