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Request Information

Thank you for your interest in Pioneer Valley Christian Academy!

Please fill out the form below and our Admissions Director, Lisa Kerns, will contact you to answer any additional questions you might have, as well as schedule an educational consult with one of our administrators.

Please note:  All preschool applicants must be 3 years old on or before September 1st.  Kindergarten applicants must be 5 years old on or before September 1st.


* Indicates a required field.

Parent / Guardian Information
  • First Parent / Guardian
  • First Name *
  • Last Name *
  • Salutation *
  • Email Address *
  • Confirm Email Address *
  • Gender *
  • Work Phone
  • Cell Phone
  • Second Parent / Guardian
    (leave blank if not applicable)
  • First Name *
  • Last Name *
  • Salutation *
  • Email Address *
  • Confirm Email Address *
  • Gender *
  • Work Phone
  • Cell Phone
Home Address
  • Street Address *
  • City *
  • Country *
  • State
    *
  • Zip
    *
  • Home Phone *
  • How Did You Hear About Us? *
    Details:

  • If you are interested in taking a tour, please indicate the day and time you will be available.
  •  
  • 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
  •