Northern Lights Chrysalis Flight/Journey Application
All of the above information is necessary for your proper placement in the Chrysalis Weekend. Please fill in all blanks.
The cost of the weekend is $65.00 per person. We request a non-refundable $15.00 registration fee that should be given to your sponsor along with your completed application.
The remaining amount will be collected at the Registrar’s table upon arrival.
Please make checks payable to the Northern Lights Chrysalis Community. Full scholarships are available.
This form is an application and its submittal does not guarantee acceptance.
You may be placed on a waiting list since we only have a certain number of spaces available.
Applicants will be notified of acceptance by mail several weeks before the Chrysalis Flight/Journey.
To be filled out by the Parent/Guardian if participant under 18 years old:
This Applicant has my permission to attend the Chrysalis weekend. In the event of an emergency and if I/we cannot be reached by phone, Northern Lights Chrysalis has permission to secure the services of licensed medical professionals to provide the care necessary, including anesthesia, for my child’s well-being.