Register at St. Benedict

Adult 1

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.
Birthdate (MMDDYYYY) Please enter a date.
Gender
Religion
First Communion
Confirmed
Adult 1 Marital Status
Occupation/Employer Please enter valid data.

Adult 2

First Name (Optional) Please enter valid data.
Last Name (Optional) Please enter valid data.
Birthdate (MMDDYYYY) Please enter valid data.
Gender
Religion
First Communion
Confirmed
Adult 2 Marital Status
Occupation/Employer Please enter valid data.

Contact Information

Street Address REQUIRED Please fill out this field. Please enter valid data.
City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.
Phone Number REQUIRED Please fill out this field. Please enter a phone number.
Email REQUIRED Please fill out this field. Please enter an email address.
Second Email (Optional) Please enter valid data.
Do you want to receive donation envelopes? Yes No No, I will use online giving
May We List Address and Phone Number in Church Directory? Yes No

Comments or Remarks

Please Contact Me About (Check all that apply): Baptism Prep First Communion/First Penance Prep Confirmation Prep Marriage Prep Registering my children at St. Benedict School Making an Appointment with the Pastoral Coordinator

Child 1

First Name Please enter valid data.
Last Name Please enter valid data.
Birthdate (MMDDYYYY) Please enter valid data.
Gender
Religion
First Communion
Confirmed

Child 3

First Name Please enter valid data.
Last Name Please enter valid data.
Birthdate (MMDDYYYY) Please enter valid data.
Gender
Religion
First Communion
Confirmed

Child 4

First Name Please enter valid data.
Last Name Please enter valid data.
Birthdate (MMDDYYYY) Please enter valid data.
Gender
Religion
First Communion
Confirmed

Register at St. Benedict

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