Members of the Babysitting Club Express Form Member Number*What is your Babysitting Club Membership Number?Name* First Last Mobile Number*The number you can be reached at.Date*Date of the Booking. Date Format: DD slash MM slash YYYY Please allow ~15-20 minutes for a brief orientation and verbal instructions of the Carer before you depart.Start Time* : HH MM AM PM End Time* : HH MM AM PM Children In Care*Please provide the name(s) and age(s) of the children to be in care.Duties and Routine*Duties and Routine for the Booking.COVID-19 Family DeclarationThe health and well-being of our Nannies is our highest priority. As a result of the COVID-19 pandemic and as part of our Workplace Safety Policy, we require all our Nannies to complete the COVID-19 infection control training module through the Australian Government Department of Health. This covers the fundamentals of infection prevention and control for COVID-19. As a condition of Booking our Services please answer the questions below:- We ask for your full support as we all have a shared responsibility to minimise the risk of exposure and to protect our individual and collective health. Please let us know if you have any questions or concerns and we thank you for your co-operation. Are you or your family presenting any of the following symptoms relating to COVID-19? • Fever • Cough • Shortness of breath*Are you or your family presenting any of the following symptoms relating to COVID-19? • Fever • Cough • Shortness of breath Yes No Have you or your family recently been in contact with someone diagnosed with coronavirus to your knowledge?*Have you or your family recently been in contact with someone diagnosed with coronavirus to your knowledge? Yes No Have you or your family recently travelled outside Australia in the last 2 weeks?*Have you or your family recently travelled outside Australia in the last 2 weeks? Yes No As a precautionary measure, if you respond ‘YES’ to any of these questions, we will be unable to assist you at this time. We ask for your full support as we all have a shared responsibility to minimise the risk of exposure and to protect our individual and collective health. Please let us know if you have any questions or concerns and we thank you for your co-operation. NameThis field is for validation purposes and should be left unchanged.