Chrysalis Caterpillar Application

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January 16-18, 2027

Fellowship UMC

2511 New Salem Hwy, Murfreesboro

Email *

Name *

Birthdate *

You are a: *

Youth (ages 13-17)

Young Adult (ages 18-24)

Male

Female

Required

Name as you would like it on your name tag: *

Address *

T-shirt Size *

XXL

Other:

Current school / completed year *

School Activities

(Youth only) Has the Chrysalis weekend been explained to you by your Parent/Guardian/Sponsor? *

Yes

Have the follow up Gatherings been explained to you? *

Yes

State briefly why you would like to attend a Chrysalis weekend and what you hope to gain from it? *

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