Mercy Launch Application Form

Mercy Launch Application Form

Please fill out your details and answer the questions to apply for the program. Deadline to submit application for Intro Track is Friday, June 26, 2026. Deadline to submit application for Advanced Track is July is Friday, July 10th, 2026.
Which program are you applying for?
Student's Full Name

First NameLast Name
Parent/Guardian Full Name

First NameLast Name
Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Student's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Student's Email Address
example@example.com
Parent/Guardian Email Address
example@example.com
School Attending
Grade Entering
Emergency Contact (Name and Phone Number)
Do you have a current business or plan on starting a business?
If yes, tell us about your business or why you would like to start one.
Describe why you want to participate in the Mercy Launch Program.
By signing below, the student and parent/guardian acknowledge and agree to the terms and conditions of the Mercy Launch Program. Signer grants permission to Mercy Goods, the City of Richmond Texas Development Corporation, Mercy Launch partners, agents, and employees the right to reproduce the photographs and/or images taken of me/my child for the purposes of publication, promotion, illustration, advertising or trade. You acknowledge you have read and understood the terms and conditions of this application and give your consent for your child to participate in the program. You agree your child will fully complete each day of the program. There will only be one two-hour session that will be considered excused in order to complete the program.
Student Signature
Parent/Guardian Signature
Should be Empty: