rWorld Family Registration Form

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Please fill out this form with your child's first and last name. Then answer the following questions to help us prepare for your family and follow up later. If you have more than (3) children to register, you must submit the form multiple times, or simply register your child / children, and we can quickly register any additional children at the time of your visit.

Email *

REVO Church is one church in multiple locations. Which location are you planning to visit?

REVO Church - North (7105 Broad St. Rural Hall, NC 27045)

REVO Church - South Fork (3830 Wayne Ave Winston Salem, NC 27104)

REVO Church - Walkertown (5185 Sullivantown Rd Winston Salem, NC 27051)

Clear selection

Today's Date *

YYYY

Parent/Guardian Name *

Relationship to Child *

Parent

Legal Guardian

Grandparent

Extended Family (Aunt, Uncle, Cousin, etc.)

Other:

Cell Phone Number *

Street/Mailing Address *

City, State, ZIP *

Home Phone Number

First Child

Full Name *

Age *

Grade *

Birthday *

YYYY

Gender *

Boy

Girl

Special Needs

Allergies

Second Child

Full Name

Age

Grade

Birthday

YYYY

Gender

Boy

Girl

Clear selection

Special Needs

Allergies

Third Child

Full Name

Age

Grade

Birthday

YYYY

Gender

Boy

Girl

Clear selection

Special Needs

Allergies

Are there any custody issues we need to know about?

A copy of your responses will be emailed to the address you provided.

Submit

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