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.