Date of Birth: 
Tuesday, 6 September, 0016
Other information: 
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Gender: 
Girl
School: 
83
Emergency Contact: 
74
Emergency Contact Phone Number: 
18
Parent / Guardian: 
Bessy
17
72
10
Relationship of Emergency Contact to the Child: 
46
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: 
Louise