Event registration

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Details

2025 Term 3 School Holiday Clinic

Tue 23 Sep 2025 09:00 — Thu 02 Oct 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 23 September

$80.00 ea

Wednesday 24 September

$80.00 ea

Thursday 25 September

$80.00 ea

Tuesday 30 September

$80.00 ea

Wednesday 1 October

$80.00 ea

Thursday 2 October

$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.*