Application to Team
Mail form to: Tidewater Chrysalis PO Box 8534, VA Beach, VA 23450
Email: tidewaterchrysalisregistrar@gmail.com
Email address *
Full Name *
Date of Birth *
Gender *
Adult or Youth teamer *
Address: Street *
City *
State *
Zip code *
Home Phone
Cell Phone *
School you attend
Grade
Church you attend *
Pastor Name
Has the Chrysalis Weekend and the follow-up gatherings been explained to you?
Clear selection
Do you play an instrument or sing
Clear selection
If instrument, which ones
Please list any chrysalis or emmaus weekends on which you have served as well as your assigned role on these weekends *
Please list all medications *
Do you have any allergies or other medical conditions *
Do you have a special diet, please specify *
Are you a first time adult teamer *
First time adult teamers since shirt change will receive a tshirt and chrysalis cross (past caterpillars not included)
Teamer E-Sign *
by filling in your name electronically, you agree to all terms and conditions for this position
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