Register for a Chrysalis Flight |

We are currently experiencing technical issues with the website. When submitting an application for a pilgrim or team, if you receive an error message, please note the website is forwarding the application. If you have a question about whether it was received, please email centralmsemmaus@gmail.com

To register for a Chrysalis flight online, please complete the following Caterpillar application:

Fill out all required fields below, click “I am not a Robot”. When you have been verified, then click the submit button. If you are not directed to the Home Page, scroll up through your form entry and check for errors.

The application process is considered complete when both the Caterpillar and the Sponsor applications have been received.

Register for a Chrysalis Flight

* Required Fields
T-shirt Size*
Caterpillar Last Name:*
Caterpillar First Name:*
Application Date*
MM slash DD slash YYYY
Caterpillar Address*
Street Address City State ZIP Code
Caterpillar Phone*
Caterpillar Email (Acceptance to weekend will be sent to this email):*
Gender:*
Date of Birth:*
Desired Name on Tag:*
Rising Grade:*
Sponsor Name*
First Last
Sponsor Phone*
Sponsor Email*
School You Attend*
School Activities*
Which Flight?*
Pastor's Name:*
Church and Community Activities*
Has Chrysalis been explained to you?*
Has the Follow-up program of Group Reunions and Gatherings been explained to you?*
State briefly why you wish to participate in Chrysalis and what you expect from it:*
Please enter "yes" to confirm you have completed this application and agree to the following dress code: Chrysalis Dress Code: What you can wear: t-shirts, polo shirts, sweat shirts, walking shorts, capris, sweat pants, lounge pants and long pants. What NOT to wear: sleeveless shirts, halters, tank tops, short shorts, short skirts and No stomach showing.*
Please enter "yes" to confirm this applicant has my permission to attend the Chrysalis weekend. In the event of an emergency and if I cannot be reached by phone, the Chrysalis staff has my permission to secure services of licensed medical professionals to provide necessary care, including anesthesia, for my child’s well-being.*
Parent/Gardian Contact Phone*
If above cannot be reached, please contact the following:*
Backup Contact Phone*
Please list any medical allergies, medications being taken, medical problems, special diet, or other pertinent information. If these do not apply, please type none.*
IMPORTANT: Please notify your sponsor you have completed and electronically submitted your application for a Chrysalis flight. You will be notified as to your acceptance and the dates of your Chrysalis weekend. Please notify your sponsor and us immediately at the email address below if you cannot attend, as there may be a waiting list. Email: cmschrysalis@yahoo.com. I have read the above notification (PLEASE SELECT YES OR NO).
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Register for a Chrysalis Flight

Register for a Chrysalis Flight

* Required Fields

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