New Student Application Form

New Student Application Form

Child’s First Name:*

Answer Required

Child’s Last Name:*

Answer Required

Child's Middle Name:

Answer Required

Date of Birth:*

Answer Required

Sex:*

Answer Required

Present Grade:*

Answer Required

Grade in August:*

Answer Required

Address

Street Address:*

Answer Required

City:*

Answer Required

Zip/Postal:*

Answer Required

Primary Phone Number:*

Number Required

Main or 1st Language spoken at home:*

Answer Required

2nd Language:

Answer Required

School Child Currently Attending:*

Answer Required

City:

Answer Required

Child’s place of Birth:

Answer Required

Country:

Answer Required

Mother's Information

First Name:*

Answer Required

Middle Name:

Answer Required

Last Name:*

Answer Required

Address:

Street Address:

Answer Required

City:

Answer Required

Zip/Postal:

Answer Required

Primary Phone Number:*

Number Required

Email: *

Answer Required

Religion:*

Answer Required

Mother's Place of Birth

City:*

Answer Required

State:*

Answer Required

Country*

Answer Required

Mother's Employment Information

Occupation*

Answer Required

Employer*

Answer Required

Phone

Number Required

Employer's Address

Street Address

Answer Required

City*

Answer Required

Zip/Postal

Answer Required

Mother’s Marital Status (choose one)

Father’s Information

First Name:*

Answer Required

Middle Name:

Answer Required

Last Name:*

Answer Required

Street Address:

Answer Required

City:

Answer Required

Zip/Postal:

Answer Required

Email:

Answer Required

Primary Phone Number:*

Number Required

Religion*

Answer Required

Father’s Place of Birth

City:*

Answer Required

State*

Answer Required

Country*

Answer Required

Father’s Employment Information

Occupation:*

Answer Required

Employer*

Answer Required

Phone:

Number Required

Street Address:

Answer Required

City:

Answer Required

Zip/Postal:

Answer Required

Marital Status (choose one)

If Applicable Complete the Following (choose one):

Answer Required

Step-Mother

Step-Father

Legal Guardian

Contact Information

First Name

Answer Required

Middle Name

Answer Required

Last Name

Answer Required

Mobile Phone

Number Required

Work Phone

Number Required

City:

Answer Required

State:

Answer Required

Country:

Answer Required

Occupation:

Answer Required

Employer

Answer Required

Marital Status

Answer Required

Married

Single

Separated

Divorced

Remarried

Widowed

Religion

Answer Required

Relationship to Child

Answer Required

List all Children Attending St. Benedict School

Student Name:

Answer Required

Student Name

Answer Required

Student Name:

Answer Required

Student Name:

Answer Required

Please state reason for selecting Saint Benedict School for your child:

Answer Required

Sacramental Information

Baptism

Answer Required

Yes

First Communion

Answer Required

Yes

Confirmation

Answer Required

Yes

Baptism

Date

Answer Required

Church

Answer Required

City

Answer Required

Zip/Postal

Answer Required

First Communion

Date

Answer Required

Church

Answer Required

City

Answer Required

Zip/Postal

Answer Required

Confirmation

Date

Answer Required

City

Answer Required

Zip/Postal

Answer Required

Parish Information

Are you currently a registered member of Saint Benedict Parish? No If yes, Envelope# _________*

Answer Required

Does your child attend CCD? Yes No If yes, Parish: _________________________ City: _______________State: _______________

Answer Required

Do you live within the geographical boundaries of Saint Benedict Parish? Yes No If not, in what Parish do you reside? Name: _________________________________

Answer Required

Signature*

Signature Required

Please fix the highlighted areas below before submitting.

New Student Application Form