1740 Randolph Rd.  Middletown, CT  06457-5155  860.346.6659

Summer Program Registration

When appropriate grade is selected below, applicable programs and classes will populate. 

Which programs would you like to register for?

Other Programs
For Credit Courses - Select one
Prep
Summer Enrichment

Student Information

Mother's Information

Father's Information

Waiver Regarding a Medical Emergency

I hereby give permission for my daughter to participate in the Mercy High School Summer Programs. I certify that she is in good health. I have listed any allergies and medical conditions she has, and all medications she is taking, below, of which Mercy High School Summer Program personnel should be aware.

Photography Waiver

We occasionally include photos of Mercy students and guests on our website, in publications, press releases, and social media. Please check the appropriate box.

Required Documents

In order to complete your registration, you must mail in the following documents:

Physician verification

Letter or statement from your daughter's physician stating she is or is not able to participate in physical activities and/or stating any limitations

Proof of medical insurance

The student must be covered by a parent or guardian's medical insurance policy. Proof of medical insurance must be submitted by mail or email before the start of the program(s). In addition, a parent/guardian must sign and submit the Medical Emergency Waiver that is part of online registration.

Participants in full day programs must bring their own lunch. Mercy will not provide lunch. Refrigerators will be available.

Please mail required documents to:

Mercy High School - Attn: Mrs. Melissa Bullock
1740 Randolph Rd. Middletown, CT 06457-5155

Terms and Conditions

I hereby agree not to hold Mercy High School or any person associated with the Mercy High School Summer Programs liable or responsible for any accident, injury or loss which may occur as a result of the daughter's participation in the Mercy High School Summer Programs. I authorize Mercy High School Summer Program personnel to act for me according to their best judgement in any emergency requiring medical attention.

In the event that I cannot be located, Mercy High School Summer Program personnel have my permission to administer first aid or take my daughter to a doctor or hospital to be treated. In case of injury, I understand that I am responsible for all financial liabilities. I hereby release and discharge the school, program staff, the Mercy High School Summer Programs and affiliated entities and their officers, agents and employees from and against any and all liability or cause of action arising out of or in connection with student participation in the Program.

Please digitally sign and date below:

Total cost: $0.00