Flights are for high school sophomores, juniors, and seniors (ages 15-18).

The candidate must fill out the top portion of this application and the sponsor must fill out the bottom portion.

Please DO NOT submit an incomplete application.

If information is left off this application, it will not be accepted. If you do not list your contact information, there's no way for us to confirm this application with you.

If you can't fill out in person together but still wish to submit your application online, contact your candidate to get the information below or Download the Paper Application.

Please notify us immediately if you cannot attend, others on a waiting list may be able to attend if contact soon enough to prepare.


Chrysalis Application

Candidate Section

Weekend Date
Invalid Input

Candidate Name(*)
Invalid Input

Gender
Invalid Input

Phone Number
Invalid Input

Age
Invalid Input

Date of Birth
Invalid Input

Home Address (with City, State, and Zip Code)
Invalid Input

Email
Invalid Input

School
Invalid Input

Invalid Input

Church now Attending
Invalid Input

Pastor's Name
Invalid Input

Has Pastor Attended a Chrysalis or Emmaus?
Invalid Input

List School Clubs and Activities
Invalid Input

Are you on special medication or a diet?
Invalid Input

Are you Vegetarian?
Invalid Input

Do you have any health problems or physical handicap that may affect your attending?
Invalid Input

Has Chrysalis Been Explained to You?
Invalid Input

What would you like to receive from this weekend?
Invalid Input

Please list any medical allergies, medications being taken, medical problems or other pertinent information
Invalid Input

Insurance Company
Invalid Input

Policy Number
Invalid Input

Doctor
Invalid Input

Doctor's Phone
Invalid Input

Sponsor Section

Sponsor's Name
Invalid Input

Sponsor's Address (With City, State, & Zip)
Invalid Input

Sponsor's Home Phone
Invalid Input

Sponsor's Mobile Phone
Invalid Input

Sponsor's Email Address(*)
Invalid Input

Sponsor's Church
Invalid Input

Location and Date of YOUR Walk/Flight
Invalid Input

Name of ReUnion Group Attending
Invalid Input

How long have you known your candidate?
Invalid Input

Why do you feel this person would be a good candidate?
Invalid Input

Are you willing to assist your candidate in finding a ReUnion group?
Invalid Input

Will you bring your candidate to registration?
Invalid Input

Will you attend sponsor's hour?
Invalid Input

Will you attend closing?
Invalid Input

Will you attend Follow-Up?
Invalid Input

Invalid Input

Calendar

18 May
Men's Walk #198
Date 05.18.2023 - 05.21.2023
18 Aug
Flight #41
08.18.2023 - 08.20.2023
6 Oct
Flight 42
10.06.2023 - 10.08.2023