St. Benedict Parish
2018-2019
Religious Education Registration
Family Last Name:
*
Today"s Date:
*
-
Month
-
Day
Year
Date
Mother's First Name and Maiden Name:
Father's First Name:
Preferred Phone:
*
Custodial Parent, if different from above:
Email:
*
Address:
*
Are both parents Catholic?
*
Yes
No
City
*
State
*
Zip
*
If no, which religious affiliation?
CHILD
First Name:
*
Last Name:
*
Gender:
*
Male
Female
Grade Level:
*
School:
*
Date of Baptism:
-
Month
-
Day
Year
Date
Catholic Baptism?:
Yes
No
Church of Baptism:
City, State
Date of First Eucharist:
-
Month
-
Day
Year
Date
Church of First Eucharist:
City, State
Date of First Reconciliation:
-
Month
-
Day
Year
Date
Church of First Reconciliation:
City, State
Date of Confirmation:
-
Month
-
Day
Year
Date
Church of Confirmation:
City, State
Any Special Needs, such as Medical, Learning Disabilities, Physical Disabilities?
Please indicate Religious Education class preference:
*
Sunday - 8:45AM - 10:15AM
Wednesday - 6:30PM - 8 PM
CHILD
First Name:
Last Name:
Gender:
Male
Female
Grade Level:
School:
Date of Baptism:
-
Month
-
Day
Year
Date
Catholic Baptism?:
Yes
No
Church of Baptism:
City, State
Date of First Eucharist:
-
Month
-
Day
Year
Date
Church of First Eucharist:
City, State
Date of First Reconciliation:
-
Month
-
Day
Year
Date
Church of First Reconciliation:
City, State
Date of Confirmation:
-
Month
-
Day
Year
Date
Church of Confirmation:
City, State
Any Special Needs, such as Medical, Learning Disabilities, Physical Disabilities?
Please indicate Religious Education class preference:
Sunday - 8:45AM - 10:15AM
Wednesday - 6:30PM - 8 PM
CHILD
First Name:
Last Name:
Gender:
Male
Female
Grade Level:
School:
Date of Baptism:
-
Month
-
Day
Year
Date
Catholic Baptism?:
Yes
No
Church of Baptism:
City, State
Date of First Eucharist:
-
Month
-
Day
Year
Date
Church of First Eucharist:
City, State
Date of First Reconciliation:
-
Month
-
Day
Year
Date
Church of First Reconciliation:
City, State
Date of Confirmation:
-
Month
-
Day
Year
Date
Church of Confirmation:
City, State
Any Special Needs, such as Medical, Learning Disabilities, Physical Disabilities?
Please indicate Religious Education class preference:
Sunday - 8:45AM - 10:15AM
Wednesday - 6:30PM - 8 PM
Additional Comments/Concerns:
ADDITIONAL FORMS:
Please CLICK HERE
to download and fill out the necessary forms. Feel free to mail them or drop them off at the Rectory.
PAYMENT INFORMATION
Will you be mailing in a check?
Yes
No
Please make checks payable to:
St. Benedict Parish, and mail to 2215 W. Irving Park Road, Chicago, IL 60618
If you would prefer to pay by credit card, go to:
givecentral.org
. You must submit this registration form first, before going to GiveCentral.
Submit
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