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Health declaration

Please fill out the following:

Date of birth
Day
Month
Year
Are you suffering from a medical condition, illness or injury that would affect your ability to participate in these classes?
No
Yes

Anakie & District Community Group

Address

Wadawurrung Country

2115 Geelong Ballan Road, Anakie, Victoria 3213  (MAP)

Ofiice Hours
(during Victorian school terms)

Mon, Tues, Thurs

Weds

9:00 am – 4:00 pm

12:00pm –5:00 pm

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