Application

GraceWorks Alaska
4149 Checkmate Dr.
Anchorage, AK 99508

907-440-4974
gograceworks@aol.com

Spring Xtreme 2019

March 9-14; March 16-21; March 23-28; March 30- April 4 (circle one)



Name ______________________________________ Birthdate ___________________________________

Address ____________________________________________________________________________________

City _______________________________ State __________________ Zip ________________

Phone (cell)__________________________ Email _______________________________________________

Employer (if student, name school) _____________________________________________________________

Church where you attend ______________________________________________________________________

Past Ministry Experience ______________________________________________________________________

Health Concerns or Disablities? (if so, please detail on the back)

Emergency Contact Name and phone ____________________________________________________________

Please attach (1) a brief recommendation email from your pastor, church pastoral staff member or someone else in who knows you well (2) $50 deposit to hold your place – applied to your total. (3) We also require applicants to send us a background check before you come. Send payment to: GraceWorks, 4149 Checkmate Dr, Anchorage, AK 99508.

GraceWorks Alaska is a 501(c)(3)

tax-exempt organization.

All donations are tax deductible

as allowed by law.