Purchase Area Chrysalis Sponsor Information
This form should be completed by the applicant's sponsor. Ideally, this is someone who has attended a Purchase Area 4th Day Community event such as Chrysalis, Walk to Emmaus, or Face-to-Face.
Sponsor Name
*
First Name
Last Name
Participant Name
*
First Name
Last Name
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
When & Where did you attend Chrysalis or Emmaus?
*
Sponsor Responsibilities
Have you fully explained Chrsyalis to your applicant?
*
Please Select
Yes
No
Have you fully explained Chrysalis to the youth parents/guardian?
*
Please Select
Yes
No
Will you pray and sacrifice for your applicant?
*
Please Select
Yes
No
Will you bring your applicant to Send-Off?
*
Please Select
Yes
No
Will you attend Sponsor's Hour, Candlelight and Closing?
*
Please Select
Yes
No
Will you bring your applicant to the Chrysalis/Emmaus Gatherings?
*
Please Select
Yes
No
Will you bring your applicant to the Chrysalis Rush when it is held?
*
Please Select
Yes
No
If your answer was no to any of the above, will you arrange for a person to fulfill those responsibilities?
*
Special Needs of the Applicant
Does your applicant have the physical & mental health needed to attend this Weekend?
*
Please Select
Yes
No
Is your applicant under any emotional strain that might indicate that participation be postponed?
*
Please Select
Yes
No
Have the parents/guardians of your applicant participated in Emmaus or Chrysalis?
*
Please Select
Yes
No
Are there any additional circumstances concerning the applicant of which the Chrysalis team should be aware?
*
Please Select
Yes
No
It is important that the adult leadership of Chrysalis be aware of any physical, spiritual, or emotional challenges that this person may have. Please provide comments that will help us to understand and deal sympathetically with him or her. Comments that would elaborate on any of the above answers would be greatly appreciated. These comments are held in the strictest confidence.
*
Sponsor, please remember the Chrysalis Weekend is an intense program of Christian study and spiritual growth. It is NOT a weekend retreat or cure-all. It is good if the applicant is active in church or a campus mainline religious organization, desires an opportunity to grow in Christ and enhance their participation in Church. As a sponsor, you also understand that although you may be present during the weekend, you are not to be seen by your applicant. If at any time you have questions regarding your applicant or the Weekend, please contact the Chrysalis Board.
Signature
*
Registration fee of $25 payable to Purchase Area Chrysalis. Payment can be made via Tithe.ly at https://bit.ly/4thDay-Tithely or mailed to the Purchase Area Chrysalis Community Registrar, C/O Erin Beliles, 5119 US Hwy 68 W, Benton, KY 42025. Registration is $100. The remaining will be due the morning of Registration. If you have any questions or for more information, please contact Erin Beliles at (270) 210-0508.
Continue
Continue
Should be Empty: