NORTHWEST OHIO CHRYSALIS
Information to be completed by Sponsor
Name of Caterpillar: _____________________________________________
Sponsor's Information:
Name: ______________________________________Address: _________________________________
City
: ___________ State: _____ Zip: ________Phone:(__)___________
E-Mail___________________________________
Church / denomination you attend: _______________________________________________________
Do you attend regularly? Y / N      Have you served as a sponsor before? Y / N
Where did you attend your Emmaus / Chrysalis / Cursillo / Great Banquet?__________________
When? ______________________    Are you in a Share Group? Y / N
Are you receiving the Northwest Ohio Chrysalis Newsletter? Y / N
How long have you known the Butterfly? ___________________________
Why do you think this person would benefit from the Chrysalis weekend? _______________________
______________________________________________________________________________________
Does the Butterfly have any physical or mental health concerns that the Spiritual Director or the
Lay Director should be aware of? _________________________________________________________
To your knowledge, does your butterfly have a fear of clowns? ________________________________
Especially for girls' flights, it is imperative that you explain to your butterfly that there will be
 a clown ministry on the flight weekend.
After explaining this, to your knowledge, does your butterfly have a fear of clowns?

The following are some of your responsibilities as this Butterfly's sponsor. Please read each one and
indicate that you understand it (initial, check, etc.).
• ____ To pray and sacrifice for the Butterfly. Collect and number 15 agape letters for Butterfly.
• ____ To provide, or personally arrange for, transportation for the Butterfly to and from the weekend.
• ____ To attend Sponsor's Hour (or to inform the Spiritual Director that you cannot).
• ____ To attend Closing, etc. 
• ____ To explain Hoots and Share Groups to Butterfly.
• ____ To help the Butterfly find a Share Group (Community Reps also help with this).
• ____ To provide 2 2L of drink/pop, 1 bag of candy and 1 snack for your butterfly.

Also, please be aware of the importance of minimal contact with your Butterfly during the weekend.
Please make any additional comments you believe may be helpful:___________________________
____________________________________________________________________________
You will receive further information concerning your responsibilities and a reference form to complete
closer to the flight weekend. Sponsoring a person on a Chrysalis weekend is a wonderful act of agape!
Mail the Registration Form and Sponsor Form to the following address (with the $15 registration fee) to:

Vicki Adam
NWO Chrysalis Registrar
9031 Stitt
Whitehouse,OH 43571 

Phone: 419-878-2326
Email: registrar@nwochrysalis.org or vadam@roadrunner.com

NOTE: The registration and sponsor forms are available at: www.nwochrysalis.org . You can print the forms, fill them out,
scan them and send as an email attachment. Do keep in mind that if the butterfly is under the age of 18, the registration
must be signed by a parent. If you do choose to email the forms, then please follow-up by mailing the $15.00 deposit
 (with the name of the butterfly clearly indicated) to one of the mailing addresses provided above. Forms cannot be faxed.