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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.

Dr. Justin Jordan, Head of School

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Parent / Guardian Information
  • First Parent / Guardian
  • Last Name *
  • First Name *
  • Email Address *
  • Gender *
    Male    Female
  • Work Phone
    (Ex: 999-999-9999)
  • Cell Phone
    (Ex: 999-999-9999)
  • Second Parent / Guardian
    (leave blank if not applicable)
  • Last Name *
  • First Name *
  • Email Address *
  • Gender *
    Male    Female
  • 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 now ($100 application fee), please check YES in the box below and we will send you a link to our online application.

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