Alongside Inc.

• Name First Last

   

• Email
• Phone (###-###-####)
• Address
  Street Address
  Address Line 2
  City
  State / Province / Region
  Postal / Zip Code
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• Name of Mission Board or Church
• Denomination (if applicable)
• Retreat dates for which you are applying
• Number of people attending

• (Childcare can be arranged for a fee of $100/child)

  Children’s names & ages
• Is childcare being requested?
  Yes No
• Specific needs or goals in attending the retreat
• Are any prospective participants currently suffering with suicidal thoughts/tendencies or experiencing psychotic symptoms which are not currently under control with medication?
• Is chemical/substance dependency or addiction a primary reason for seeking help at this time?
• Are there any other special needs/issues of which we should be aware?
• How did you learn about Alongside?

Once your application has been approved, we require a $500 non-refundable deposit to secure your place.

We are excited about the possibility of meeting you and serving you. Thank you for taking the time to answer these questions. Your answers to these questions will help us determine if we can be helpful to you or if you might be better served in some other way. In the event that ALONGSIDE determines that this ministry would not likely be significantly helpful for your needs, we will attempt to inform you of other caregiving options of which we are aware.