Harrisburg Adventist School Contact Request
100%
Questions marked with an * are required Exit Survey
 
 
Tell us about your request
 
 
 
* Request Type (select all that apply)
 
I am interested in enrolling a child
 
I would like to talk to someone about the school
 
I have a question for Ms. Kelley
 
I have a question for Mr. Brown
 
I have a question for Ms. Pinter
 
I have a question for Ms. Ponti
 
I have a question about school uniform orders
 
I have a question for the school board
 
I have a question or comment about the web site
 
Other

 
 
 
Message or Request
   
 
 
 
* How did you hear about us?
 
Word Of Mouth
 
Internet Search
 
Our Website
 
At My Church
 
Where I Work or Shop
 
Print Advertisement
 
Other Advertisement
 
Other
 
 
 
 
Information about your child
 
 
 
* Child Name
   
 
 
 
* Child Age
   
 
 
 
* If you are interested in enrolling a child, what grade will they be in when they start school with us?
   
 
 
 
Information about you
 
 
 
* First Name : 
* Last Name : 
Address 1 : 
Address 2 : 
City : 
State : 
Zip : 
* Phone : 
* Email Address : 
 
 
 
* Contact Preference (Check all the apply)
 
Telephone
 
Email
 
US Postal Mail

 
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