Date of Birth: 
Monday, 27 June, 0033
Other information: 
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Gender: 
Girl
School: 
41
Emergency Contact: 
18
Emergency Contact Phone Number: 
67
Parent / Guardian: 
Lillian
42
61
55
Relationship of Emergency Contact to the Child: 
83
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: 
Ali