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Request Information

Thank you for your interest in Our Lady of Mercy Regional Catholic School!

Please fill out the form below, and our Admissions Office will contact you shortly to provide additional information regarding your request.

* Indicates a required field.

Parent / Guardian Information
  • First Parent / Guardian
  • First Name *
  • Middle Name
  • Last Name *
  • Salutation *
  • Email Address *
  • Confirm Email Address *
  • Work Phone *
  • Cell Phone *
  • Second Parent / Guardian
    (leave blank if not applicable)
  • First Name *
  • Middle Name
  • Last Name *
  • Salutation *
  • Email Address *
  • Confirm Email Address *
  • Work Phone *
  • Cell Phone *
Home Address
  • Street Address *
  • City *
  • Country *
  • State
    *
  • Zip
    *
  • Home Phone *
  • How Did You Hear About Us? *
    Details:
  •  
  • Student 1
  • First Name *
    Middle Name
    Last Name *
  • Birthdate *
    (mm/dd/yyyy)
    Gender *
  • Grade Level of Interest *
    School Year *
  • Current School

  • Does your child have any learning disabilities?
    * Yes   No

  • Does your child take any medications? 
    * Yes   No

  • Current Parish - if applicable
    *
  •  
  • Is There Another Student?
    Yes No
  •  
  • Parent / Guardian Notes
  •