Date of Birth: 
Saturday, 11 March, 0017
Other information: 
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Gender: 
Girl
School: 
15
Emergency Contact: 
19
Emergency Contact Phone Number: 
36
Parent / Guardian: 
Rosemary
65
62
97
Relationship of Emergency Contact to the Child: 
91
School Year: 
10
I agree that my child may receive emergency medical treatment by a trained member of staff or medical practitioner if needed: 
Doctor Address: 
Clair