Group List
Total quantity sold : 353 Date Billing First name Billing Last name Billing Company Billing E-mail Billing Phone Billing City Billing State Variation Order Qty Total _billing_diocese 2022-10-06 jennifer Rosher St. Thomas [email protected] 5086979528 East Bridgewater MA 48 Boston 2022-10-05 Debbie Kitchen Our Lady of the Fields [email protected] 4107332770 Millersville MD 20 Archdiocese of Baltimore 2022-10-05 Theresa Andary Prince of Peace [email protected] 2317443321 Muskegon MI 9 Grand Rapids 2022-10-05 Christine Folsom-Kovarik Mary, Mother of God [email protected] 9082298909 HILLSBOROUGH NJ 16 Metuchen 2022-10-05 Sheila Bauer Apple Valley Catholic Community [email protected] 978-263-4305 Acton MA 50 Boston 2022-10-05 Michele Harding Church of the Assumption [email protected] 2032228486 Westport CT 16 Bridgeport, CT 2022-10-05 Nicolaus Schmitz St. Lawrence [email protected] 6782403072 Lawrenceville GA 35 Atlanta 2022-10-03 Allison Provinsal Fiat Ventures [email protected] (973) 500-3300 Warren NJ 75 Metutchen 2022-10-03 Brian Flanagan St. James [email protected] (908) 280-1865 Basking Ridge NJ 49 Metuchen 2022-09-30 Linda Darling Holy Cross Church [email protected] 3026745787 Dover DE 35 Wilmington Email selected customers
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| Participant Name | Nickname | Parish / Group | Have you attended CHWC before? | How many years? | Gender | Shirt Size | Age Category (at the time of camp) | Grade entering in the fall of 2023 | Cell Phone | First Choice Service Assignment | Second Choice Service Assignment | Construction: | Concrete/Masonry: | Drywall: | Painting: | Plumbing: | Electrical: | Any comments to help place you on a team? | Are there any health issues we need to know about before placing you at a worksite? | Other Jobs at Camp | Participant Date of Birth | Emergency Contact | Emergency Contact, Relationship to Participant | Emergency Contact, Phone Number | Health Status: Please list any health problems you may have | Please list all medications taken routinely (over the counter and prescription) | Physician Name | Physician Phone Number | Date of your last Tetanus Booster | Health Insurance: Provider | Health Insurance: Policy Number | Health Insurance: Group Number | RELEASE OF ALL CLAIMS | MEDIA WAIVER | CODE OF BEHAVIOR | Participant Signature | Custodial Parent Name | Custodial Parent Signature | Custodial Parent Email | SIGNATURE AGREEMENT | Are you a member of clergy or professed religious? | Please Specify | Entry ID | Sequence Number | Entry Date | Delete Entry Link | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Rev. Steven Restrepo | St. Thomas | Yes | 1 | Male | Medium | Adult (21 and older) | (857) 413-6665 | Work project (painting, indoor clean up, maintenance, repair work, outdoor yard work) | Work at a social service center (homeless shelter, food distribution center) | 2 | 1 | 1 | 3 | 1 | 1 | If I can be placed in an assignment with Jen Rosher the leader of the St. Thomas group that would be helpful. | Priest: Help with Liturgy/Reconciliation & go to a worksite | 04/01/1993 | Kacthary Sanclemente | Cousin | (617) 818-5012 | Dr. Patricio Cabral | (857) 307-2200 | 11/26/2019 | Tufts Health Plan | 992557175 | 01 | AGREE | AGREE | AGREE |  | AGREE | Yes | Priest | 356 | 1 | January 27, 2023 9:31 PM | ||||||||||
Reese Porro | St. Thomas | No | Female | Medium | Youth (under 18) | 9th | Work with children at day care centers for low-income families | Work project (painting, indoor clean up, maintenance, repair work, outdoor yard work) | 1 | 1 | 1 | 1 | 1 | 1 | Sensitivity to heat and sun | 03/16/2009 | Katie Porro | Mom | (617) 794-6052 | Dr Victoria Tan | (508) 584-1234 | 04/11/2014 | Blue Cross Blue Shield Anthem | U2N675W03403 | 270113M0A0 | AGREE | AGREE | AGREE | Katie Porro |  | AGREE | 355 | 2 | January 27, 2023 6:28 PM | |||||||||||||
Katie Porro | St. Thomas | No | Female | Medium | Adult (21 and older) | (617) 794-6052 | Work with children at day care centers for low-income families | Work project (painting, indoor clean up, maintenance, repair work, outdoor yard work) | 1 | 1 | 1 | 3 | 1 | 1 | Sensitivity to heat and sun | 12/15/1978 | Matt Porro | Spouse | (508) 944-3327 | Dr Dyan Bhatia | (508) 350-2300 | 01/01/1990 | Blue Cross Blue Shield Anthem | U2N675W03403 | 270113M0A0 | AGREE | AGREE | AGREE |  | AGREE | No | 354 | 3 | January 27, 2023 6:23 PM | |||||||||||||
Jonathon Murphy | Jack | St. Thomas | No | Male | Medium | Young Adult (18-20) | (774) 506-0846 | Work project (painting, indoor clean up, maintenance, repair work, outdoor yard work) | Work with children at day care centers for low-income families | 2 | 1 | 2 | 3 | 2 | 2 | 08/30/2004 | Mj Murphy | Mother | (508) 245-6763 | David Chung | (508) 584-1210 | 09/09/2009 | BCBS | MTN983129888 | O | AGREE | AGREE | AGREE |  | AGREE | No | 347 | 4 | January 27, 2023 8:18 AM | |||||||||||||
Linda Howard | St. Thomas | Yes | 1 | Female | Medium | Adult (21 and older) | (508) 942-6215 | Work at a social service center (homeless shelter, food distribution center) | Work with children at day care centers for low-income families | 1 | 1 | 1 | 2 | 1 | 1 | Associate Staff: Stay at home base and work behind the scenes with the HEART staff. | 07/08/1963 | Tom Howard | husband | (508) 989-7132 | Good Health | Synthroid 100 mcg daily | Dr. Kathleen Gilson | (508) 941-0497 | 07/29/2021 | Blue Cross Blue Shield | MTP981489780 | 004000989 | AGREE | AGREE | AGREE |  | AGREE | No | 274 | 5 | January 23, 2023 7:16 PM | ||||||||||
Jacob Howard | St. Thomas | Yes | 1 | Male | Medium | Youth (under 18) | 11th | Work project (painting, indoor clean up, maintenance, repair work, outdoor yard work) | Work project (painting, indoor clean up, maintenance, repair work, outdoor yard work) | 3 | 3 | 1 | 3 | 3 | 3 | 12/14/2006 | Linda Howard | Mother | (508) 942-6215 | Doctor Kevin Murphy | (508) 584-1210 | 02/09/2018 | Blue Cross Blue Shield | MTP981489780 | 004000989 | AGREE | AGREE | AGREE | Linda Howard |  | AGREE | 273 | 6 | January 23, 2023 7:10 PM | |||||||||||||
Drew Silvia | St. Thomas | No | Male | Medium | Youth (under 18) | 9th | Work project (painting, indoor clean up, maintenance, repair work, outdoor yard work) | Work with children at day care centers for low-income families | 3 | 2 | 2 | 2 | 2 | 1 | Interest in construction | None | 04/13/2009 | Sarah Silvia | Mother | (774) 259-2522 | None | None | Dr Fred Kern | (508) 697-8116 | 06/20/2022 | Harvard Pilgrim | HP2553771 | HP2553771 | AGREE | AGREE | AGREE | Sarah Silvia |  | AGREE | 248 | 7 | January 21, 2023 12:26 PM | ||||||||||
Noah Gibson | St. Thomas | No | Male | Large | Youth (under 18) | 11th | Work project (painting, indoor clean up, maintenance, repair work, outdoor yard work) | Work at a social service center (homeless shelter, food distribution center) | 4 | 2 | 1 | 4 | 1 | 1 | I'm a boy scout. | No. | 08/08/2007 | Kimberly Gibson | mother | (508) 596-9387 | None | None | Dr. Britt Pena | (508) 584-6060 | 08/20/2018 | Blue Cross Blue Shield MA | XXP983830447 | 002347905 | AGREE | AGREE | AGREE | Kimberly Gibson |  | AGREE | 224 | 8 | January 19, 2023 7:59 PM | ||||||||||
Jennifer Rosher | Jen | St. Thomas | Yes | 4 | Female | Small | Adult (21 and older) | (617) 828-9147 | Work project (painting, indoor clean up, maintenance, repair work, outdoor yard work) | Work at a social service center (homeless shelter, food distribution center) | 3 | 2 | 3 | 4 | 2 | 3 | None | No | 10/20/1976 | Brian Rosher | Husband | (617) 594-6903 | Migraines | Methocarbamol, Rizatriptan, Nabumetone | Mrecia | (508) 350-2300 | 06/12/2017 | BCBS | UEW983199803 | None | AGREE | AGREE | AGREE |  | AGREE | No | 206 | 9 | January 19, 2023 5:38 PM | ||||||||
Brett Schmitz | Brett | St. Lawrence | No | Female | Small | Youth (under 18) | 8th | Work at a social service center (homeless shelter, food distribution center) | Work with children at day care centers for low-income families | 1 | 1 | 1 | 1 | 1 | 1 | not very tall | allergic to blueberries | 09/21/2009 | Nic Schmitz | Dad | (706) 818-9401 | none | epipen if she eats blueberries | Dr. Melissa Martin | (706) 548-7909 | 09/21/2012 | Meritain Health | 3619666926 | 10974 | AGREE | AGREE | AGREE | Nic Schmitz |  | AGREE | 202 | 10 | January 19, 2023 5:16 PM | |||||||||
Nic Schmitz | Nic | St. Lawrence | Yes | 5 | Male | 2XL | Adult (21 and older) | (706) 818-9401 | Work at a social service center (homeless shelter, food distribution center) | Work with children at day care centers for low-income families | 1 | 1 | 1 | 3 | 1 | 1 | n/a | Had Lower back surgery | Associate Staff: Stay at home base and work behind the scenes with the HEART staff. | 01/25/1979 | Jessica Schmitz | Wife | (678) 677-6950 | Lower Back Surgery | None | Dr. Richard Maxa | (697) 597-3180 | 05/27/2022 | Meritain Health | 3619666926 | 10974 | AGREE | AGREE | AGREE |  | AGREE | No | 184 | 11 | January 19, 2023 2:26 PM |