Masai's Playhouse New Enrollment

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Thank you for contacting us regarding your need for childcare.
Please complete this form to provide us with information about your child/children and your family’s specific needs.

Email *

Which of our child care services are you interested in? *

MPH Preschool and Childcare Program (Accepting age 30 months and up)

Night Watch Childcare (Accepting infants and up)

Drop-in Care Service

How did you find us? Facebook, personal referral, Yelp, google search etc. (please include full name of personal referral) *

Parent/Guardians full name: *

Contact number to receive an automated text that an email invitation has been sent: *

Child’s Name *

Child’s age AND date of birth *

Days and hours of care needed? *

Will this be short term or long term care? *

Short term (1 year or less)

Long term (1 year or more)

Potential start date? *

Has your child/children ever been in a preschool or daycare setting before: *

If yes, what was the reason for leaving your previous/current care provider or facility? *

Any behavioral issues or other problems at their last daycare/preschool, if so please describe the behaviors and behavioral plan in place: *

Has your child had any issues with self harming or harming other children (biting, hitting, scratching, pinching, head banging etc.) if so please describe issues and behavioral/redirection plan in place: *

Is your child/children eating table foods regularly: *

Yes, eating solids confidently

Still working on solids

If child is not eating solids are they formula fed, breastfeeding or take a liquid nutritional supplement/meal replacement? *

Potty trained or still diapering? If potty trained how long has child been successfully toileting on a consistent basis? *

Any allergies or food restrictions? If so please detail. *

Any special needs or special accommodations required? *

What are some important qualities or program offerings you seek in a potential childcare provider? *

Is there any other information you would like to add? *

MPH LLC. has been a long standing and trusted source for childcare, preschool and 24/7 care in our community due to our unique program offerings and policies such as our "Health and Safety Policies and Procedures" Have you had a chance to visit our website to view our program offerings AND policies? View MPH LLC. Health and Safety Policies *

Yes

Other:

If we do not have openings available at this time, would you like to be placed on our waiting list? You will receive an email confirmation that you have been added to the waiting list. *

Yes

A copy of your responses will be emailed to the address you provided.

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