New Family Registration

Your name *

Last name

Email address *

Gender *

Select…MaleFemale

Marital status

Select…SingleMarriedWidowedEngaged

Phone number *

Phone type

MobileHomeWorkOther

Household members

+ Add adult+ Add child

Address *

HomeWorkOther

Country

Country

Street address

Apt/unit/box (optional)

City

State

Postal code

Is this your first time visiting Revolution Church? *

Yes

No

What Ministry are you visiting today? *

Wednesday Worship Night

Kids (Birth - 5th Grade)

Youth (6th - 12th Grade)

Special Needs

The Landing (Celebrate Recovery Teenagers)

If attending the Broadcast Campus, which service will you be attending? *

8:30am Service

10:00am Service

11:30am Service

Which campus will you be attending *

Broadcast Campus (8:30, 10, and 11:30AM)

411 Campus (10am)

Select if your child requires an IEP or Special Assistance

Submit

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