St. Walter-St. Benedict Admission Form
Primary Campus St. Walter = Kindergarten - Gr. 4        
PreK and Upper Grade Campus St.Benedict = Preschool 3 &4 yr., Grades 5 - 8

For the application to be complete, please fill out this form and submit it to the school office with your child's birth certificate and baptismal certificate (if baptized). Please complete one admission form per child.

$100 Application fee may be paid at either school, application is not considered to be complete until the fee is paid in full.  (Returning families from St. Walter and St. Benedict Schools would pay a $50 re-enrollment fee rather than the $100 new student enrollment fee).
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Student Full Name (Last, First) *
Student Birthdate *
MM
/
DD
/
YYYY
Gender *
Student Birthplace (City/State) *
Student Grade for 2021-2022 *
If Preschool, please choose
Clear selection
Student Allergies/Medical Conditions *
Does this student have an IEP (Individualized Education Plan) or 504 Plan *
Street Address *
City *
State *
Zip Code *
Race (choose one or more) *
Ethnicity:  Is this student Hispanic/Latino? *
Religion *
Registered at a Parish *
Baptism Parish, City, State (if Catholic)
Catholic Sacraments Completed (if child is Catholic )
Who does student live with (primary residence)? *
Does this child reside at any other household? *
If YES, please explain below
Please list all languages spoken at home *
What language does the child speak primarily?
Clear selection
Which language does family prefer communication from school?
Clear selection
Last School Attended (write N/A if applicable) *
Public School District where you reside (list unknown if unsure) *
#1 Parent/ Guardian First and Last Name *
#1 Main Phone Number (please use format 111-222-3333) *
#1 Parent/Guardian E-mail address *
#1 Employment Title  
#1 Employer  
#1 Marital Status *
If Remarried, please list name of step parent
#2 Parent/ Guardian First and Last Name
#2 Main Phone Number please use format (111-222-3333)
#2 Parent/Guardian E-mail address
#2 Employment Title  
#2 Employer  
#2 Marital Status
Clear selection
If Remarried, please list name of step parent
Parents/Guardians agree to share contact with Archdiocesan High Schools *
I agree to provide any forms/documentation via email, fax or directly to the school. *
I understand that there is a $100 non-refundable new student application fee per student and I need to provide the school office with an original birth certificate, baptismal certificate (if applicable) and Health Immunization records. Returning students from St. Walter or St. Benedict School will need to pay a family $50 fee.  New students with current siblings at either school pay an additional $25 enrollment fee to the family fee. *
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