NOTARY REQUIRED IF APPLICANT IS UNDER 18
Subscribed and sworn to before me, (Name of Notary)
A Notary Public, in Parish/County, Louisiana/Texas the day of , 20 Signature of Notary Public My Commission expires
RETURN FORM, COPY OF INSURANCE CARD & PAYMENT TO YOUR SPONSOR
Cross Bayou High School Chrysalis Application MEDICAL AUTHORIZATION - REQUIRED BY ALL APPLICANTS REGARDLESS OF AGE
COST OF FLIGHT IS $100.00.
Make all checks payable to Cross Bayou Chrysalis, THIS FORM, A COPY OF INSURANCE CARD & PAYMENT MUST BE RETURNED TO YOUR SPONSOR
TO BE COMPLETED BY SPONSOR COST OF FLIGHT IS $100.00. Make all checks payable to Cross Bayou Chrysalis
Your Name Phone Number Address City State Zip Email Address Your church Three day weekend that you attended When Where? Walk / Flight # yes no - Does your candidate have the physical and mental health needed for Chrysalis Flight weekend? yes no - Have you informed the candidate that they should expect to have NO outside contact during the weekend, except in case of emergency? yes no - Have you explained that all flights are SMOKE FREE events? yes no - Will you personally bring the candidate to the site? yes no - Are you praying for your Candidate? yes no - Help your candidate get into a reunion group? yes no - Have you explained the follow up meeting? As a sponsor, are you willing to say "YES" to Christ - to fulfill your responsibilities so that His grace and love are revealed through your actions?
Mail Completed forms and fees to: Donna Kemp - Registrar 4778 Dorcheat Rd. Minden, LA 71055 email dkbkemp@yahoo.com Phone (318) 377-4428 (H) (318) 422-7589 (C)