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Sample CPR - the Leicester City, Leicestershire and Rutland ...

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Form <strong>CPR</strong><br />

Parts B & C – Extended family<br />

Part B – O<strong>the</strong>r people with parental responsibility<br />

Does anyone else have parental responsibility for <strong>the</strong> child? (i.e. legal<br />

guardian or special guardian) 23<br />

Name NOT APPLICABLE<br />

Relationship to <strong>the</strong><br />

child<br />

How was PR obtained?<br />

Gender<br />

Date of birth<br />

Ethnicity<br />

Nationality<br />

Address<br />

Page 38<br />

© BAAF 2006<br />

All rights reserved. Except as permitted under <strong>the</strong> Copyright, Designs <strong>and</strong> Patents Act 1988, this form may not be<br />

reproduced, stored in a retrieval system, or transmitted in any form or by any means, without <strong>the</strong> prior written permission<br />

of <strong>the</strong> publishers. A Licence Agreement permitting electronic reproduction of this form can be purchased from BAAF.<br />

Published by BAAF, Saffron House, 6–10 Kirby Street, London EC1N 8TS

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