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Enrolment Form

Access Authorisation: I give authority for the child referred to in this confidential record nominate the following person/s as contacts as follows:

Contact 1:

Gender:

Please tick the box/es below to confirm the level of authorisation you give to this person:

Contact 2:

Gender:

Please tick the box/es below to confirm the level of authorisation you give to this person:

Contact 3:

Gender:

Please tick the box/es below to confirm the level of authorisation you give to this person:

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