Date of Birth: 
Wednesday, 16 October, 0047
Other information: 
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Gender: 
Girl
School: 
23
Emergency Contact: 
91
Emergency Contact Phone Number: 
37
Parent / Guardian: 
Karely
59
68
19
Relationship of Emergency Contact to the Child: 
21
School Year: 
12
I agree that my child may receive emergency medical treatment by a trained member of staff or medical practitioner if needed: 
Doctor Address: 
Katrina