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Request Information

Thank you for your interest in Pinon Hills Academy or Promisland Child Development Center!

Please fill out the form below and we will contact you and provide the information you desire.

Tim Kienitz, Head of School

* Indicates a required field.

Parent / Guardian Information
  • First Parent / Guardian
  • First Name *
  • Last Name *
  • Email Address *
  • Gender *
  • Work Phone
    (Ex: 999-999-9999)
  • Cell Phone
    (Ex: 999-999-9999)
  • Second Parent / Guardian
    (leave blank if not applicable)
  • First Name *
  • Last Name *
  • Email Address *
  • Gender *
  • Work Phone
    (Ex: 999-999-9999)
  • Cell Phone
    (Ex: 999-999-9999)
Home Address
  • Street Address
  • City
  • Country
  • State
  • Zip
  • Home Phone
    (Ex: 999-999-9999)
  • How Did You Hear About Us?
    Details:
  • If you are ready to apply for admission for your child for the current school year ($75 application fee), please check YES in the box below and we will send you a link to our online application.  If you are interested in appplying for next school year, the open season for applications will begin in mid-March.  You can still check YES, but you will not be sent the link to apply until that option is open.

    Yes   No
  •  
  • Student 1
  • First Name *
    Last Name *
  • Birthdate *
    (mm/dd/yyyy)
    Gender *
  • Grade Level of Interest *
    School Year *
  • Current School
  •  
  • Is There Another Student?
    Yes No
  •  
  • Parent / Guardian Notes
  •