Date of Birth: 
Saturday, 7 July, 0035
Other information: 
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Gender: 
Girl
School: 
79
Emergency Contact: 
45
Emergency Contact Phone Number: 
94
Parent / Guardian: 
Andy
94
92
16
Relationship of Emergency Contact to the Child: 
41
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: 
Mayah