Chrysalis Flight #57

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Chrysalis Flight is a three-day spiritual renewal retreat for high school girls and guys who are between the ages of 15 to 18, grades 10-12th, and provides an opportunity to learn more about faith, to experience Christian love and support, and a chance to make new commitments in their faith journey.

You will need a sponsor to attend the weekend. This can be someone in the Chrysalis, Emmaus, Tres Dias, or other three day community who knows you. They will need to submit a sponsorship form (link at evvchrysalis.com)

The weekend will take place at Camp Illiana located at 723 E 450 S, Washington, IN 47501. Chrysalis Flight 57 is February 24-26, 2023.

Chrysalis is open to members of any Christian denomination.

Chrysalis is for the development of Christian leaders who:

Have a desire to strengthen their spiritual lives
May have unanswered questions about their faith
Understand that being a Christian involves responsibility
Are willing to dedicate their everyday lives to God in an ongoing manner

If these statements describe you, then we would love for you to apply!

Email *

Candidate's Name (First & Last) *

You will need a Sponsor who has attended Chrysalis, Emmaus, Tres Dias, or another Third Day weekend. What is your Sponsor's name? *

Sponsor's contact number? *

Sex *

Female

Male

Candidate Email *

Candidate Contact Number *

Parents Name *

Parents Email *

Address *

City, State, Zip Code *

Your Birthday *

YYYY

School or Employment *

Grade in school *

Name and Denomination of church you attend *

Pastor or Youth Director's Name *

Pastor or Youth Director's Phone Number *

Pastor or Youth Director's Email *

What church/religious activities are you involved in? *

Has Chrysalis been explained to you? *

Yes

Has reunions and follow-up meetings been explained to you? *

Yes

Are you on a special diet? If so what? *

Are you on medication? If so what? *

Do you have a health problem or physical handicap that may affect your attendance? *

State briefly why you want to be involved in Chrysalis Community. *

Will you be riding the bus from Evansville to Camp Illiana on Friday morning? *

Yes

T-Shirt Size *

Payment of $75 has been made (copy/paste this link to pay): https://www.powr.io/checkout_screen?unique_label=5be815f2_1547222993 *

Yes I have paid

My Sponsor has agreed to cover payment

I will need financial assistance

I agree to abide by the rules and directions of the Chrysalis Leadership Team on this weekend. (Your electronic signature shows agreement to statement) *

(Parental Consent) If you are under the age of 18, a parent must sign the following: I am the parent or legal guardian of this participant, and hereby grant my permission for him/her to participate in said activity, and hereby give my permission for the Chrysalis staff to authorize medical treatment, including but not limited to emergency surgery or medical treatment, and assume the responsibility of all medical bills, if any, and do also hereby give permission for my child to ride in any vehicle designated by the Chrysalis staff while attending and participating in the aforementioned activities. I also hereby assume all risk of personal injury, sickness, death, damage and expense as a result of participation in recreation and activities involved therein, and agree to hold harmless the EVANSVILLE AREA CHRYSALIS and the directors thereof from any and all liability. (Your electronic signature shows agreement to statement)

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms