Event registration

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Details

2026 Term 3 School Holiday Clinic

Tue 22 Sep 2026 9:00AM - Thu 01 Oct 2026 3:00PM
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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 22nd September *

$80.00 ea

Wednesday 23rd September *

$80.00 ea

Thursday 24th September *

$80.00 ea

Tuesday 29th September *

$80.00 ea

Wednesday 30th September *

$80.00 ea

Thursday 1st October *

$80.00 ea

Please note

A Booking fee of $2.50 applies once to this order for tickets marked with *.

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