Tidewater Chrysalis Participant Application
Greetings! We are excited to welcome you on the weekend experience. Tidewater Chrysalis will be held at Triple R Ranch Columbus Day Weekend If you have any issues accessing or submitting this form please contact (Call or Text) the Chrysalis Registrar at 757-572-3787 or email to tidewaterchrysalisregistrar@gmail.com
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Email *
Full Name *
Name for your Nametag (If you go by something different than your first name)
Date of Birth *
MM
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DD
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YYYY
Gender *
Street Address:  *
City *
State *
Zip Code *
Participant Cell Phone Number *
School you attend *
Grade *
Church you attend *
Who is your sponsor?  *
Has the Chrysalis Weekend and the follow-up gatherings been explained to you? *
Do you play an instrument or sing *
If instrument, which ones
What is your shirt size? *
Required
State briefly why you wish to participate in Chrysalis and what you expect from this weekend. *
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