Student Name*

First Nickname Last

Student Address*

Street Address Address Line 2 City State ZIP Code

Home Phone*

Parent's Primary Email*

Date of Birth*

School Grade in Sept. 2020*

Rel. Ed. Grade in Sept. 2020*

Name of School for 2020-21*

Which program will you be attending:*

Would you like to add a second student?*

Yes
No

Second Student's Name*

First Nickname Last

Is the second students address the same?

Yes
No

Second Student's Address

Street Address Address Line 2 City State ZIP Code

Second Student's Home Phone*

Second Child's Date of Birth*

Second Student's School Grade in Sept. 2020*

Second Students Rel. Ed. Grade in Sept. 2020*

Second Student's Name of School for 2020-21*

Which program will the second student be attending:*

Would you like to add a third student?*

Yes
No

Is the third students address the same?

Yes
No

Third Student's Address

Street Address Address Line 2 City State ZIP Code

Third Student's Home Phone*

Third Child's Date of Birth*

Third Student's School Grade in Sept. 2020*

Third Students Rel. Ed. Grade in Sept. 2020*

Third Student's Name of School for 2020-21*

Which program will the third student be attending:*

Would you like to add a fourth student?*

Yes
No

Is the fourth students address the same?

Yes
No

Fourth Student's Address

Street Address Address Line 2 City State ZIP Code

Fourth Student's Home Phone*

Fourth Child's Date of Birth*

Fourth Student's School Grade in Sept. 2020*

Fourth Students Rel. Ed. Grade in Sept. 2020*

Fourth Student's Name of School for 2020-21*

Which program will the fourth student be attending:*

Would you like to add a fifth student?*

Yes
No

Is the fifth students address the same?

Yes
No

Fifth Student's Address

Street Address Address Line 2 City State ZIP Code

Fifth Student's Home Phone*

Fifth Child's Date of Birth*

Fifth Student's School Grade in Sept. 2020*

Fifth Students Rel. Ed. Grade in Sept. 2020*

Fifth Student's Name of School for 2020-21*

Which program will the fifth student be attending:*

Religious Education Registration 2020-21

Step 1 of 6

Father's Information

Mother's Information

Payment

Upcoming Events

Vigil Mass for the Feast of the Immaculate Conception

Parish Advent Retreat

Immaculate Conception

Advent Penance Service at St. Benedict’s

Vigil Mass for the Feast of the Immaculate Conception

Parish Advent Retreat

Immaculate Conception