Name of child: Ben AdamDate of birth: 2nd November 2000
Emergency contact details
Contact person 1
Surname: AdamFirst name/s: KathyAddress: 666 High Grove KINTOWN 6111Home telephone:9111 4610Work telephone: N/APlace of work/study: DailyHours usually available: Monday to Saturday - All hoursRelationship to the child: GrandmotherSignature of above person sighted by Cybertots staff member? Yes
Contact person 2
Surname: BlakeFirst name/s: GinaAddress: 6 Grove Avenue THE DOWNS 6111Home telephone:9222 1234Work telephone:9222 0710Place of work/study: The Downs CafeHours usually available: Monday to Friday 2.00pm - 6.00pmRelationship to the child: AuntySignature of above person sighted by Cybertots staff member? Yes