Admissions - Mercy safe Haven Academy

1 Personal
Details

2 Academic Info

3 Parent/Guardian

4 Additional
Info

First Name

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Last Name

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Date of Birth

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Gender

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Grade Applying For

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Previous School

Previous Grade

Academic Achievements

Extracurricular Activities

Parent's First Name

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Parent's Last Name

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Relationship to Student

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Please enter a valid email address

Phone

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Emergency Contact

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Address

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Occupation

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Special Needs (if any)

Medical Conditions (if any)

Additional Notes