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St. Benedict Church
TERRE HAUTE, IN
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Home
About
About Us
Welcome
Staff
Contact Us
History
Windows of St Benedict Church
Tour
Newcomers
Welcome Newcomers!
Sacramental Guidelines
Register
Becoming Catholic
Returning Catholic
Resources
Bulletins
Prayer Request
Faith
Liturgy
Mass Times
Confession Times
Parish Life
Parish Life
Homilies
Sacraments
Ministries
Ministries
Liturgical Ministry
Global Solidarity
Our Faith
Our Faith
Being Catholic Today
What is the Catholic Church?
What Do Catholics Believe?
We are the Church
Religious Education
Religious Education Registration
Youth Ministry
RCIA
Events & News
Parish Calendar
News
Photo Albums
Religious Education Registration
Religious Education
Religious Education Registration
Youth Ministry
RCIA
Religious Education Calendar 2023-24
Religious Education Calendar 2023-24
St. Benedict Religious Education Registration 2023-24
The maximum number of form submissions has been reached. This form is currently not available.
Registered in this parish?
REQUIRED
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No
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If not registered at St. Benedict Church, in what parish are you registered?
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Media Release
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Would you please give your permission for your child's picture and name to appear in St. Benedict's media releases such as St. Benedict's website, Facebook page, parish bulletin, parish videos and other parish media releases?
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No
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Family Information
Family Name
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Address 1
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Address 2
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City
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State
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Zip
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Father's Name & Religion
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Mother's Name & Mother's Maiden Name & Religion
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Phone Number
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Maximum 20 characters
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Secondary Phone Number
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Email
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Emergency Contact (First and Last Name):
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Emergency Contact Relationship
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Emergency Phone Number
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Maximum 20 characters
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Children to Register
REQUIRED
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Child 1
First Name
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Last Name
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Birthdate (mm/dd/yy)
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Gender
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Male
Female
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Grade
REQUIRED
(Select One)
Pre-school
Kindergarten
1
2
3
4
5
6
7
8
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Sacraments Completed
REQUIRED
Baptism
Eucharist
Reconciliation
Confirmation
None
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Class Preference
Child 2
First Name
REQUIRED
Please fill out this field.
Please enter valid data.
Last Name
REQUIRED
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Please enter valid data.
Birthdate (mm/dd/yy)
REQUIRED
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Gender
REQUIRED
Male
Female
Please fill out this field.
Grade
REQUIRED
(Select One)
Pre-school
Kindergarten
1
2
3
4
5
6
7
8
Please fill out this field.
Sacraments Completed
REQUIRED
Baptism
Eucharist
Reconciliation
Confirmation
None
Please fill out this field.
Class Preference
Child 3
First Name
REQUIRED
Please fill out this field.
Please enter valid data.
Last Name
REQUIRED
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Please enter valid data.
Birthdate (mm/dd/yy)
REQUIRED
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Please enter valid data.
Gender
REQUIRED
Male
Female
Please fill out this field.
Grade
REQUIRED
(Select One)
Pre-school
Kindergarten
1
2
3
4
5
6
7
8
Please fill out this field.
Sacraments Completed
REQUIRED
Baptism
Eucharist
Reconciliation
Confirmation
None
Please fill out this field.
Class Preference
Child 4
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 (mm/dd/yy)
REQUIRED
Please fill out this field.
Please enter valid data.
Gender
REQUIRED
Male
Female
Please fill out this field.
Grade
REQUIRED
(Select One)
Pre-school
Kindergarten
1
2
3
4
5
6
7
8
Please fill out this field.
Sacraments Completed
REQUIRED
Baptism
Eucharist
Reconciliation
Confirmation
None
Please fill out this field.
Class Preference
Additional Details
Special Needs/Medication
Please list child's name & needs. Send procedure plan to parish office if needed. Please include anything we may need to know about your child (ren) such as allergies, special learning needs, health conditions or family situations we should be aware of (for each child). This information will only be shared with the child's catechist.
Check here if parents are divorced
Child resides with:
Mother & Father
Mother
Father
Other
Who is the custodial parent?
May non-custodial parent receive reports on child? Please respond below.
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Parent Signature
REQUIRED
I acknowledge that as the parent/guardian, this information will be submitted to the parish for use in registration.*
Yes
Please fill out this field.
Payment Information
Checks and Credit Cards are accepted. Checks can be made payable to St. Benedict Church If you would like to pay by credit/debit card (MasterCard, Visa, Discover). Please call the parish office with your credit card information at 812-232-8421 extension 110
NOTE: SECOND GRADE ONLY: A baptismal certificate is required for second grade students who are preparing for First Communion. If baptized at St. Benedict, please indicate the year of baptism. If baptized at another church, please indicate on the registration form. You will need to provide a copy of the baptismal certificate as soon as possible after the beginning of the school year. Information needed: Date of baptism, Name of Church, City/Town/State, Father's Name, Mother's Maiden Name. If all information is not entered on the actual certificate, please provide the additional information. Please inform DRE if your child has not been baptized.
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