Group List
Total quantity sold : 237 Date Billing First name Billing Last name Billing Company Billing E-mail Billing Phone Billing City Billing State Variation Order Qty Total _billing_diocese 2023-01-26 Jen Metzger St. Peter the Fisherman [email protected] 715-490-4362 Eagle River WI 12 Superior 2023-01-19 Tina Schnarr St. Pius X [email protected] 317-466-3370 Indianapolis IN 8 Indianapolis 2023-01-10 Mikayla Anderson St John the Baptist Catholic Church [email protected] 651-633-8333 New Brighton MN 12 St. Paul and Minneapolis 2022-12-30 Fr. Dean Probst St. Thomas [email protected] 618-783-8741 Newton IL 19 Springfield in Illinois 2022-12-04 JAMES CHILDERS Saint Patrick's [email protected] 12177142944 SAINT JOSEPH IL 10 Peoria, IL 2022-11-18 Melissa Reinhart St. Joseph, Freeburg [email protected] 6189792412 FREEBURG IL 19 Belleville Dioecese 2022-11-17 Michael Casey Church of St William (MN) [email protected] 7635715600 Fridley MN 7 St Paul and Minneapolis 2022-11-15 Laura Hack Youth Life KY - Good Shepherd & Ss. Francis and John [email protected] 502-227-4511 Frankfort KY 19 Lexington 2022-11-07 Krystyna Wojcik-Majka St. John Brebeuf [email protected] 847-966-8145 Niles IL IL 14 Chicago 2022-11-07 Aubri Bourge St. Mary's Sycamore [email protected] 3098267709 Sycamore IL 16 Rockford 2022-10-27 Katie Pyles St Gall Catholic Church [email protected] 815-761-5496 Elburn IL 6 Rockford 2022-10-24 Melissa Montenegro Christ the King [email protected] 5099461675 Richland WA 29 Yakima 2022-10-05 Nick Radunz Mary of the Visitation [email protected] 3202905578 Becker MN 30 St. Cloud 2022-10-05 Marta Robak St. Zachary Parish [email protected] 8479561264 Des Plaines IL 13 Chicago 2022-10-05 Dawn Roesch St. Joseph the Worker [email protected] 2178994334 Chatham IL 23 Springfield
| Contact Leader's Name | Parish/Youth Group | Camp Attending | Vehicle 1 - Type of Vehicle | Vehicle 1 - Driver's Name | Vehicle 1 - Insurance Company | Vehicle 1 - Number of Seatbelts | Add second vehicle? | Vehicle 2 - Type of Vehicle | Vehicle 2 - Driver's Name | Vehicle 2 - Number of Seatbelts | Vehicle 2 - Insurance Company | Add third vehicle? | Vehicle 3 - Type of Vehicle | Vehicle 3 - Driver's Name | Vehicle 3 - Number of Seatbelts | Vehicle 3 - Insurance Company | Add fourth vehicle? | Vehicle 4 - Type of Vehicle | Vehicle 4 - Driver's Name | Vehicle 4 - Number of Seatbelts | Vehicle 4 - Insurance Company | Add fifth vehicle? | Vehicle 5 - Type of Vehicle | Vehicle 5 - Driver's Name | Vehicle 5 - Number of Seatbelts | Vehicle 5 - Insurance Company | Add sixth vehicle? | Vehicle 6 - Type of Vehicle | Vehicle 6 - Driver's Name | Vehicle 6 - Number of Seatbelts | Vehicle 6 - Insurance Company | Add seventh vehicle? | Vehicle 7 - Type of Vehicle | Vehicle 7 - Driver's Name | Vehicle 7 - Number of Seatbelts | Vehicle 7 - Insurance Company | Add eighth vehicle? | Vehicle 8 - Type of Vehicle | Vehicle 8 - Driver's Name | Vehicle 8 - Number of Seatbelts | Vehicle 8 - Insurance Company | Add ninth vehicle? | Vehicle 9 - Type of Vehicle | Vehicle 9 - Driver's Name | Vehicle 9 - Number of Seatbelts | Vehicle 9 - Insurance Company | Departure Date & Time | Departure City & Code | Departure Airline & Flight # | Do you have a connecting flight for this trip? | Connecting City & Code | Connecting Airline & Flight # | Connecting Date / Time | Arrival Date & Time | Departure Date & Time (End of Week) | Departure Airline & Flight # (End of Week) | After the free day, will you be returning to the school stay the night? | Number of People Traveling? | Comments | Contact Leader Email | Entry ID | Sequence Number | Entry Date | Delete Entry Link |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| I am completing this Verification Form for my _______________ | Camp Attending | Name of Parish | Name of Group | Please list the names of all adults attending (18+ at the time of camp) | Verification Agreement: Parish | Verification Agreement: Community | Contact Leaders Name | Contact Leader's Signature | Contact Leader's Email | Pastor's Name | Pastor's Signature | Are there any policies your group must follow as established by your diocese? | Please explain | Entry ID | Sequence Number | Entry Date | Delete Entry Link |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Name | Camp (City) Attending | Church/Parish | Comments | Please upload your letter of suitability below | Entry ID | Sequence Number | Entry Date | Delete Entry Link | |
|---|---|---|---|---|---|---|---|---|---|
| Name | Nickname | Gender | Age Category (at the time of camp) | Grade entering in the fall of 2023 | Cell Phone | 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 | Participant Signature | Custodial Parent Name | Custodial Parent Signature | Custodial Parent Email | SIGNATURE AGREEMENT | Are you a member of clergy or professed religious? | Please Specify | Parish / Group | Camp | Entry ID | Sequence Number | Entry Date | Delete Entry Link | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 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 | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|