Our Lady of Mercy Academy

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2019/2020 Pre-K 3, Pre-K 4 & Kindergarten REGISTRATION

Please complete the form below. Required fields marked *

STUDENT INFORMATION

Sex*

Home Address

State*
Ethnicity*
A copy of your child's Birth Certificate is required. You may upload a copy here:
or drag it here.

For the 2019-2020 school year we will offer the following options:

PRE-K 3

5 MORNINGS OR 5 FULL DAYS

PRE-K 4 & kINDERGARTEN

5 FULL DAYS

Entry into Grade*
Address
State*

BAPTISM

if your child was not baptized, please enter n/a for the following selectoins.

State*
If your child was Baptized, we will require a copy of the Certificate. You may upload it here:
or drag it here.

PARENT INFORMATION

Ethnicity*

Business Address

State
Ethnicity*

Business Address

State

EMERGENCY CONTACT INFORMATION

In case of emergency and parent is not available, contact:

(please list two contacts)

PHYSICIAN INFORMATION

Allergies and other Medical Conditions
A copy of your child's most recent Universal Health Record provided by your Pediatrician is required. You may upload a copy here
or drag it here.

PAYMENT INFORMATION

You have my permission to include my contact information on class lists for distribution*
My choice of tuition plan is:*
Grade as of 9/19*

PICTURE USE POLICY

Occassionally we will use pictures and video of students both internally and externally in our advertisements and social media postings.  With the exception of yearbook photos, please choose your preferences below. Please be advised that we always use the utmost respect when sharing.  It is common for us to share children's class activities and achievements on Social Media and through Press Releases.

Please indicate your choice below:*
Confirmation Email