2025 Term 1 School Holiday Clinic

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Details

Tue 08 Apr 2025 09:00 — Thu 17 Apr 2025 15:00
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Ballarat East Recreation Centre, 1 Fussell Street, Ballarat East

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First name*

Last name*

Phone number*

Email address*

Address*

Participant Name*

Date of Birth*

Medical Conditions* Max. 255 characters

Allergies* Max. 255 characters

Emergency Contact Name*

Emergency Contact Number*

Secondary Emergency Contact Name*

Secondary Emergency Contact Number*

Tuesday 8th April

$80.00 ea

Wednesday 9th April

$80.00 ea

Thursday 10th April

$80.00 ea

Tuesday 15 April

$80.00 ea

Wednesday 16 April

$80.00 ea

Thursday 17 April

$80.00 ea

I am over 18, or, if I am under 18, this registration has been filled out by and endorsed by my parent or guardian.*