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

Last Name REQUIRED Please fill out this field. Please enter valid data.
Date of birth REQUIRED Please fill out this field. Please enter valid data.
Grade entering this fall: Please enter valid data.
School where they are enrolled in for 2021-2022 Please enter valid data.
Which sacraments has he/she received? REQUIRED Baptism First Communion Confirmation None of the above He/She is in need of _______________________ Please fill out this field.
Do you have a copy of their baptismal certificate? REQUIRED Please fill out this field.
Do you have a copy of their First Communion certificate? REQUIRED Please fill out this field.
Was your child enrolled in the program last school year?
What class was he/she enrolled in last year? Please enter valid data.
Mother's Name (First and Last Name) REQUIRED Please fill out this field. Please enter valid data.
Which sacraments has she received? REQUIRED Baptism First Communion Confirmation Marriage None I am lacking one or more of the above and would like more information. Please fill out this field.
Father's Name (First and Last Name) REQUIRED Please fill out this field. Please enter valid data.
Which sacraments has he received? REQUIRED Baptism First Communion Confirmation Marriage None I am lacking one or more of the above and would like more information. Please fill out this field.
Email REQUIRED Please fill out this field. Please enter an email address.
Home Address REQUIRED Please fill out this field. Please enter valid data.
City REQUIRED Please fill out this field. Please enter valid data.
Zip code REQUIRED Please fill out this field. Please enter valid data.
Is this also your mailing address? No Yes
If not, please include your mailing address below: Please enter valid data.
Home phone number Please enter valid data.
Cell Phone Number REQUIRED Please fill out this field. Please enter valid data.
Can you receive texts at this number? REQUIRED Please fill out this field.
Health Concerns or Special Needs REQUIRED Please fill out this field. Please enter valid data.
Physcian's Name and Phone Number REQUIRED Please fill out this field. Please enter valid data.
Whom may we contact in case of an emergency? REQUIRED Please fill out this field. Please enter valid data.
Student Dismissal REQUIRED
Please check all that apply.
Myself Spouse Grandparents/Relatives Friends My student has my permission to walk to the car. Please fill out this field.
Names of those authorized to pick up my student/students.
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
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  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
Parish envelope number Please enter valid data.
Please mark your preferred payment option REQUIRED
Please check preference of tuition payment
Cash/Check Credit/Debit Please fill out this field.
I understand that St. Benedict determines the number of absences to be acceptable is three.

For the safety of my student, an unauthorized person may not pick up my child without a note from the parent or a phone call to the porent verifying authorization.

To receive a sacrament, I will be in compliance with all requirements of my parish. As a parent/guardian, I am expected to attend mass with my student, Holy days of obligation and attend required parent meetings.
I Agree Please select this field.

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Saint Benedict Catholic Church

San Benito, Texas

Registration Form 2021-2022

Payment by credit card or debit. Please indicate payment is for Religious Education tuition.