Date of Birth: 
Wednesday, 26 October, 0095
Other information: 
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Gender: 
Girl
School: 
13
Emergency Contact: 
96
Emergency Contact Phone Number: 
90
Parent / Guardian: 
Leila
82
51
52
Relationship of Emergency Contact to the Child: 
53
School Year: 
11
I agree that my child may receive emergency medical treatment by a trained member of staff or medical practitioner if needed: 
Doctor Address: 
Sydney