Date of Birth: 
Wednesday, 31 May, 0062
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Gender: 
Girl
School: 
43
Emergency Contact: 
29
Emergency Contact Phone Number: 
14
Parent / Guardian: 
Jiya
94
83
44
Relationship of Emergency Contact to the Child: 
48
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: 
Arlene