Date of Birth: 
Friday, 1 September, 0034
Other information: 
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Gender: 
Girl
School: 
71
Emergency Contact: 
56
Emergency Contact Phone Number: 
61
Parent / Guardian: 
Ahtziri
14
41
62
Relationship of Emergency Contact to the Child: 
10
School Year: 
13
I agree that my child may receive emergency medical treatment by a trained member of staff or medical practitioner if needed: 
Doctor Address: 
Mollie