*CLASS APPLIED FOR: |
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*TERM |
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*YEAR |
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*SEX |
*DATE OF BIRTH |
*AGE |
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| BROTHERS AND SISTERS STUDYING AT CHRISLAND SCHOOL |
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| HEALTH OF THE CHILD |
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| *IMMUNIZATION TAKEN: |
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| ALLERGIES TO MEDICATION: |
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| ANY OTHER DEFECT IF ANY: |
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| OTHER REMARKS: |
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| PLEASE TICK THE BOX IF DATA IS AVAILABLE |
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