Mercy Prep Track and Field Registration

Name*

First NameLast Name

Preferred Name

Date of Birth*

Date

Grade*

Authorized Driver?*

YesNo

Registration Options*

Junior High (6th-8th Grade)High School (9th-12th Grade)

T-shirt Size

Name

First NameLast Name

Preferred Name

Date of Birth

Date

Grade

Authorized Driver?

YesNo

Registration Options

Junior High (6th-8th Grade)High School (9th-12th Grade)

T-shirt Size

Name

First NameLast Name

Preferred Name

Date of Birth

Date

Grade

Authorized Driver?

YesNo

Registration Options

Junior High (6th-8th Grade)High School (9th-12th Grade)

T-shirt Size

Name

First NameLast Name

Preferred Name

Date of Birth

Date

Authorized Driver?

YesNo

Grade

Registration Options

Junior High (6th-8th Grade)High School (9th-12th Grade)

T-shirt Size

How would you like to pay?*

FACTS (3 monthly installments - skip payment information below)Credit Card (please complete information below)

Sports Payment

$395.00

Sports Payment - Sibling

$355.50 Quantity

Uniform DepositDeposit must be paid before uniform will be released.

$100.00 Quantity

Total

$0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

*Customer payment data is handled directly by Stripe Payment Processing's secure systems and is encypted and fraud compliant.

By signing you agree to the full payment of the sport registration(s) selected.

I agree to hold harmless and indemnify Mercy Preparatory Academy from any and all claims, liabilities, damages, and expenses that may arise from my child's participation in physical education, athletics, recess, or any other physical activity on or off campus. Agreement required.*

YesNo

Parent/Guardian Signature*

I agree to the use of my image or my children's image to be utilized in marketing materials such as our website, brochures, social media, and other similar publications. Approval required.*

YesNo

Parent/Guardian Signature*

Date Signed*

Date

Once you submit your registration, we will send you our Athletic Handbook that must be signed and returned prior to registration being complete. (If you have participated in a Friday Class or sports with us this year, you will not be required to sign it again).

Mercy Prep Track and Field Registration - Traditionally Enrolled Students

Parent/Guardian Information - Primary

Parent/Guardian Information - Secondary

Student Information - 1st Student

Student Information - 2nd Student (If applicable)

Student Information - 3rd Student (If applicable)

Student Information - 4th Student (If applicable)