Multiplex Employee Booking Portal

Registration

Things you’ll need

Proof of Identity
Please upload a copy of your child’s birth certificate, passport or other proof of identity. If you are booking in-centre back up care, please provide the Centre Manager with a copy on your first visit.

Immunisation Records
Please upload a copy of your child’s immunisation records. This will either be a statement issued by the Australian Government, or an immunisation statement authorised by a registered Australian doctor.

(Asterix marks compulsory fields)

Child details

Child First Name *

Child Last Name *

Child Date of Birth *

Gender *

Language used at Home *

Upload birth certificate/passport *

Upload immunization statement *

Upload medical action plan (if applicable)

Add Another Child

Primary Address

Address line one *

Address line two

Suburb *

Postcode *

State *

Medicare and Centrelink

Medicare Card Number

Medicare reference number

Please provide any health insurance details (if applicable)

Name of fund

Member number

Primary parent/carer details

Full Name *

Relationship to child *

Full Address (if different to child)

Contact phone number *

Contact email address *

Upload Site assessment form

Secondary parent/carer details (if applicable)

Full Name

Relationship to child

Full Address (if different to child)

Contact phone number

Contact email address

Emergency contact details (must be different than primary and secondary carer)

Full Name *

Relationship to child *

Full Address (if different to child)

Contact phone number *

Contact email address *

Consent to medical treatment

Authorize the administration of medication to my child if the primary/secondary carer cannot be contacted

Be notified in the case of an emergency involving the child if the primary or secondary carer cannot be contacted

Family GP & dentist

GP details

Full Name

Full Address

Contact phone number

Dentist details

Full Name

Full Address

Contact phone number

Comments

*Are there any special requirements relating to your child's culture, religion or disability that we should be aware of? If yes, please specify below
*Please provide us with a brief description of your child's likes and dislikes, any routines, toileting requirements, your child's personality and what your child finds comforting (eg. singing, rocking, a special blanket etc)
*Are there any pets in the home? Please provide details (if applicable)
*Please specify information related to Custody orders (if applicable)
*Please specify information related to Intervention service (if applicable)

Comments

By clicking on this box you agree to Guardian’s in-home backup care terms and conditions *

Multiplex |

Backup Care Booking Portal

Registration

Things you’ll need

Child details

Primary Address

Medicare and Centrelink

Primary parent/carer details

Secondary parent/carer details (if applicable)

Emergency contact details (must be different than primary and secondary carer)

Family GP & dentist

GP details

Dentist details

Comments

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