Butterfly Application

CHRYSALIS WEEKEND REQUESTED

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APPLICANT INFORMATION







MEDICAL/PHYSICAL INFORMATION

EMERGENCY CONTACT INFORMATION


COVENANT OF CONDUCT

All participants are asked to comply with the following:

  • Please leave all cell phones, watches, and electronic devices at home
  • No alcohol
  • No illegal drugs
  • No willful destruction or abuse of property
  • No smoking/ tobacco

Candidate’s Pledge:
I promise that I will come to the Chrysalis Flight with a spirit of cooperation and abide by the rules and policies stated above. I understand that violation of any rules can result in being sent home.

PARENT/GUARDIAN CONSENT


Does the Parent/Guardian listed above give permission to the Chrysalis applicant to attend Chrysalis?

In the event of an emergency, and if the Parent/Guardian listed above cannot be reached by phone, does the Chrysalis staff have permission to secure the services of licensed medical professionals to provide the care necessary, including anesthesia, for the Chrysalis applicant's well being?