New Student Application Form

New Student Application Form

Child’s First Name:*

Answer required for "Child’s First Name:"

Child’s Last Name:*

Answer required for "Child’s Last Name:"

Child's Middle Name:

Answer required for "Child's Middle Name:"

Date of Birth:*

Answer required for "Date of Birth:"

Sex:*

Answer required for "Sex:"

Present Grade:*

Answer required for "Present Grade:"

Grade in August:*

Answer required for "Grade in August:"

Address

Street Address:*

Answer required for "Street Address:"

City:*

Answer required for "City:"

Zip/Postal:*

Answer required for "Zip/Postal:"

Primary Phone Number:*

Number Required

Main or 1st Language spoken at home:*

Answer required for "Main or 1st Language spoken at home:"

2nd Language:

Answer required for "2nd Language:"

School Child Currently Attending:*

Answer required for "School Child Currently Attending:"

City:

Answer required for "City:"

Child’s place of Birth:

Answer required for "Child’s place of Birth:"

Country:

Answer required for "Country:"

Mother's Information

First Name:*

Answer required for "First Name:"

Middle Name:

Answer required for "Middle Name:"

Last Name:*

Answer required for "Last Name:"

Address:

Street Address:

Answer required for "Street Address:"

City:

Answer required for "City:"

Zip/Postal:

Answer required for "Zip/Postal:"

Primary Phone Number:*

Number Required

Email: *

Answer required for "Email: "

Religion:*

Answer required for "Religion:"

Mother's Place of Birth

City:*

Answer required for "City:"

State:*

Answer required for "State:"

Country*

Answer required for "Country"

Mother's Employment Information

Occupation*

Answer required for "Occupation"

Employer*

Answer required for "Employer"

Phone

Number Required

Employer's Address

Street Address

Answer required for "Street Address"

City*

Answer required for "City"

Zip/Postal

Answer required for "Zip/Postal"

Mother’s Marital Status (choose one)

Father’s Information

First Name:*

Answer required for "First Name:"

Middle Name:

Answer required for "Middle Name:"

Last Name:*

Answer required for "Last Name:"

Street Address:

Answer required for "Street Address:"

City:

Answer required for "City:"

Zip/Postal:

Answer required for "Zip/Postal:"

Email:

Answer required for "Email:"

Primary Phone Number:*

Number Required

Religion*

Answer required for "Religion"

Father’s Place of Birth

City:*

Answer required for "City:"

State*

Answer required for "State"

Country*

Answer required for "Country"

Father’s Employment Information

Occupation:*

Answer required for "Occupation:"

Employer*

Answer required for "Employer"

Phone:

Number Required

Street Address:

Answer required for "Street Address:"

City:

Answer required for "City:"

Zip/Postal:

Answer required for "Zip/Postal:"

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 for "First Name"

Middle Name

Answer required for "Middle Name"

Last Name

Answer required for "Last Name"

Mobile Phone

Number Required

Work Phone

Number Required

City:

Answer required for "City:"

State:

Answer required for "State:"

Country:

Answer required for "Country:"

Occupation:

Answer required for "Occupation:"

Employer

Answer required for "Employer"

Marital Status

Answer required for "Marital Status"

Married

Single

Separated

Divorced

Remarried

Widowed

Religion

Answer required for "Religion"

Relationship to Child

Answer required for "Relationship to Child"

List all Children Attending St. Benedict School

Student Name:

Answer required for "Student Name:"

Grade:

Answer required for "Grade:"

Student Name

Answer required for "Student Name"

Grade:

Answer required for "Grade:"

Student Name:

Answer required for "Student Name:"

Grade:

Answer required for "Grade:"

Student Name:

Answer required for "Student Name:"

Grade:

Answer required for "Grade:"

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

Answer required for "Please state reason for selecting Saint Benedict School for your child:"

Sacramental Information

Baptism

Answer required for "Baptism"

Yes

First Communion

Answer required for "First Communion"

Yes

Confirmation

Answer required for "Confirmation"

Yes

Baptism

Date

Answer required for "Date"

Church

Answer required for "Church"

City

Answer required for "City"

Zip/Postal

Answer required for "Zip/Postal"

First Communion

Date

Answer required for "Date"

Church

Answer required for "Church"

City

Answer required for "City"

Zip/Postal

Answer required for "Zip/Postal"

Confirmation

Date

Answer required for "Date"

City

Answer required for "City"

Zip/Postal

Answer required for "Zip/Postal"

Parish Information

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

Answer required for "Are you currently a registered member of Saint Benedict Parish? No If yes, Envelope# _________"

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

Answer required for "Does your child attend CCD?\t\tYes\t\tNo If yes, Parish: _________________________ City: _______________State: _______________"

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

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

Signature*

Signature Required

Please fix the highlighted areas below before submitting.

New Student Application Form