When

Friday, February 21, 2020 at 8:30 AM EST
-to-
Sunday, February 23, 2020 at 7:00 PM EST

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Where

South Lyon First United Methodist Church

640 South Lafayette St.
South Lyon, MI 48178

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Contact

Denise Trantham
Chrysalis of Southeast Michigan
810-348-1581
cosem.registrar@gmail.com

2020 Girl's Chrysalis Flight #68 Medical/Emergency Form

* Required information

Personal Information

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    Give our permission for her to attend the Chrysalis weekend.

Consent

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    We understand that: This will be a weekend devoted to the teaching of Christianity and the development of young Christian leaders. Chrysalis is an Ecumenical program written by the Upper Room, a division of the United Methodist Church. If she does not behave in a manner suitable to a Christian youth and the leadership deems necessary we will be responsible for picking her up at the event site promptly. She will remain at the church site, except for showers if she desires.

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    PRAYER LIST: I/We give permission for our youth's name and church affiliation to appear on a list distributed by mail/email to individuals who have agreed to pray for the Chrysalis event before/during the weekend.

Insurance and Medical

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  • All medications brought to the flight weekend must be in original bottle/container with clear instructions and in a labeled zip lock plastic bag.

Emergency Information

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    I/We give permission to the Chrysalis team to seek emergency care for our daughter during the weekend of February 21-23, 2020 in the event that emergency care is needed or in the event that neither we nor the above named person can be reached:



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