Ballarat GCO Swimming Club PIRContact DetailsChilds Name First Last Address Street Address Suburb Post Code GenderMaleFemaleEmail Emergency ContactsNameRelationshipPhone Add RemoveHealth StatementDoes the participant suffer from Asthma Diabetes Epilepsy Dizzy Spells / Black Outs Migraines OtherOther ConditionsDoes the participant have any known allergies / sensitivities ?YesNoeg. Penicillin, bee stings, hay fever, food or drug allergiesDetails on Allergies or sensitivitiesAmbulance CoverYesNoMembership NumberPrivacyDo you give permission for your child to appear in GCO Media?YesNoMedia includes but is not limited to: Facebook, Website, PR Publications, Newsletter, Photo Board, Awards book etc.
