Register at St. Benedict

Adult 1

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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
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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

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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.
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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

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