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The United Methodist Church Conference of North Central New York Young Mens/Womens co-ed CHRYSALIS Application (High school: ages 15-18) Return this form to your sponsor. TO BE FILLED OUT BY THE CANDIDATE Name___________________________ Address____________________________________ City ________..

     The United Methodist Church Conference of

    North Central New York

    Young Mens/Womens co-ed CHRYSALIS Application

     (High school: ages 15-18)

     Return this form to your sponsor.

TO BE FILLED OUT BY THE CANDIDATE

    Name___________________________ Address____________________________________

    City _________________________ State ________________ Zip Code _______________

    Phone ________________Date of Birth _________ Grade_____ email_________________

Name wished on name tag ___________________________ Sex (male/female) __________

Name and denomination

    of church now attending______________________________________________________

    School presently attending _____________________________________________________

    Religious or community organizations active In ___________________________________

    ____________________________________________________________________________ School organizations active in _________________________________________________ ____________________________________________________________________________ Are you on a special diet? ______ If so, what? ____________________________________ Are you on special medication? _______ If so, what? ______________________________ Do you have a health problem or physical handicap that may affect your attendance at Chrysalis? ______________________________________________________

    State briefly why you wish to be involved in the Chrysalis Youth Movement.

    ____________________________________________________________________________

    North Central New York

    Young Mens / Womens Chrysalis

TO BE FILLED OUT BY THE CANDIDATE

    I understand that I must remain on site the entire weekend, beginning from 9:00 am (Saturday in October / Friday in March) until about 5:00 pm (Monday in October / Sunday in March).

    Sponsor: Name: ______________________________________________________

     Address: ____________________________________________________

     Phone: _____________________________________________________

    Candidate Signature: _____________________________________________________

    Parent Signature: _______________________________________________________ All of the above information is necessary for proper placement in a Chrysalis Weekend. Please fill in all of the blanks.

    You will be notified of your acceptance and the dates and location of your weekend. It is IMPORTANT that you notify us immediately if you cannot come.

There is a waiting list.

    The cost of the weekend is $50.00. You may enclose a check when returning this form to registrars or make payment at registration table on the first day of the weekend. Checks should be made payable to: NCNY Walk to Emmaus. There are scholarships available and the cost should not keep anyone from sending in an application.

If you have the desire to attend, the money will be provided.

It is a very busy three days beginning at 9:00 am (FridayMarch / Saturday-October) and

    ending about 5:00 pm (Sunday-March / Monday-October). Candidates must stary on site the entire weekend. Therefore, persons of fragile health, or persons with serious emotional problems should not attempt a weekend. Where health or other problems do exist, it should be clearly stated on the application so that the team can be prepared. Also please be sure that your candidate is willing to attend. All applications are confidential and are destroyed after the weekend.

Please return this form to:

     Jim & Joelle Faulks

     PO Box 597

     Earlville, NY 13332

     Phone: (315) 691-6500

    PASTORS REFERENCE FORM

    TO BE FILLED OUT BY A PASTOR (or youth leader if candidate is better known to that person): Please return this form to the candidates sponsor or to: Jim and Joelle Faulks, PO Box 597, Earlville, NY

    13332 (Phone: 315-691-6500). This form should not be returned to the candidate.

This form should be filled out by the pastor. It will help us to place the candidate in a group where he/she

    will benefit the most. The Chrysalis officials will keep this information in STRICT CONFIDENCE, and all forms will be destroyed at the end of the weekend.

    Candidate Name: __________________________________________________

    Church: _____________________________ District: ____________________

††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††

    NOTE: CHRYSALIS IS A RELIGIOUS EXPERIENCE FOR SOPHOMORES,

    JUNIORS, AND SENIOR HIGH SCHOOL STUDENTS.

    ††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††

Please circle the appropriate adjective and comment as necessary.

    Exercise of Leadership: None Poor Good Excellent

    Comments: __________________________________________________________________

Maturity: Immature Average Mature Very Mature

    Comments:

    ___________________________________________________________________

    Area of leadership: Church School Athletic Social Student Government

     Dramatic Musical Other

    Comments:

    ___________________________________________________________________

    Relationship to Peers: Quiet Reticent Talkative Domineering Well-Liked

Comments:

    __________________________________________________________________

    On a separate sheet, please finish any additional comments that you feel could help the team understand and deal sympathetically with the candidate. Comments about the candidates home problems, personality problems, attitude toward life, his/her doubts, difficulties and hopes might be of great help.

    Pastor's Signature: ________________________________ Phone: ________________

Address:

    ______________________________________________________________________

    How long have you known the candidate? ______________ In what capacity have you known the candidate:

    ____________________________________________________________________________

     ___________________________________________________________________________

    SPONSOR FORM

    TO BE FILLED OUT BY THE SPONSOR:

Please send this form, reference form, and candidate’s form to: : Jim and Joelle Faulks, PO Box 597,

    Earlville, NY 13332. This form should NOT be returned to the candidate. . If you have any questions please contact the Faulks’s at the above address or by calling: 315-691-6500.

    This form should be filled out by the sponsor. It will help us to place the candidate in a group where he/she will benefit the most. The Chrysalis officials will keep this information in STRICT CONFIDENCE, and all forms will be destroyed at the end of the weekend.

     Candidate Name: _________________________________________________________________

Church : _______________________________________

    District:__________________________

    †††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††

    NOTE: CHRYSALIS IS A RELIGIOUS EXPERIENCE FOR SOPHOMORES,

    JUNIORS, AND SENIOR HIGH SCHOOL STUDENTS.

    †††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††

Please circle the appropriate adjective and comment as necessary.

Exercise of Leadership: None Poor Good Excellent

    Comments: __________________________________________________________________

Maturity: Immature Average Mature Very Mature

    Comments:

    ___________________________________________________________________

    Area of leadership: Church School Athletic Social Student Government

     Dramatic Musical Other

    Comments:

    ___________________________________________________________________

    Relationship to Peers: Quiet Reticent Talkative Domineering Well-Liked

Comments:

    __________________________________________________________________

    On a separate sheet, please finish any additional comments that you feel could help the team understand and deal sympathetically with the candidate. Comments about the candidates home problems, personality problems, attitude toward life, his/her doubts, difficulties and hopes might be of great help.

    Sponsors Signature: _______________________________ Phone: ______________

Address:

    ______________________________________________________________________

    How long have you known the candidate? ______________ In what capacity have you known the Candidate:

    _____________________________________________________________________

    Sponsors' Duties

    ; Pray for guidance of your candidate.

    ; Live the message of the weekend.

    ; Know your candidate well.

    ; Speak to God about your candidate before speaking to him/her - he/she must have a

    certain amount of maturity and open-mindedness.

    ; Prayerfully consider whether God is calling you to pay the registration for your

    candidate. Sometimes churches will pay or assist in paying the registration fee. ; Make sure your candidate is going because he/she wants to.

    Give the candidate their portion of the application to complete and return to you. You

    complete your portion and mail both of those to the registrars. At the same time, give

    the pastor’s portion of the application to the pastor (or youth leader if more familiar

    with the candidate) along with a stamped envelope addressed to the registrars for

    mailing by that person.

    ; Transport your candidate to and from the weekend and the reunion.

    You are responsible to gather agape notes for your candidate from family, close friends,

    pastor, etc. and to explain to your candidate’s parents/guardian about the hoot and holy

    hour and the importance that they be there.

    ; Support your candidate at the holy hour, with agape, and at the hoot. ; Take your candidate to reunion.

    ; Encourage your candidate to attend monthly happenings and, if feasible,

     provide transportation.

    ; Please, continue, after the weekend is over, to pray and influence them to

     grow in Christ.

    ; Your obligation is not light, guide them.

     It is a very busy three days beginning at 9:00 am (Saturday in October / Friday in

    March) and ending about 5:00 pm (Monday in October / Sunday in March).

    Candidates must stay on site the entire weekend. Therefore, persons of fragile

    health, or persons with serious emotional problems should not attempt a

    weekend. Where health or other problems do exist, it should be clearly stated on

    the application so that the team can be prepared. Also please be sure that your

    candidate is willing to attend. All applications are confidential and are destroyed

    after the weekend.

Updated Sept. 2006

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