Group List

Date Billing First name Billing Last name Billing Company Billing E-mail Billing Phone Billing City Billing State Variation Order Qty Total _billing_diocese
2023-01-26JenMetzgerSt. Peter the Fisherman[email protected]715-490-4362Eagle RiverWI21Superior
2023-01-19TinaSchnarrSt. Pius X[email protected]317-466-3370IndianapolisIN8Indianapolis
2023-01-13BrianNillesChurch of the Resurrection[email protected]563-556-7511DubuqueIA7Archdiocese of Dubuque
2023-01-10MikaylaAndersonSt John the Baptist Catholic Church[email protected]651-633-8333New BrightonMN30St. Paul and Minneapolis
2022-12-30Fr. DeanProbstSt. Thomas[email protected]618-783-8741NewtonIL18Springfield in Illinois
2022-12-04JAMESCHILDERSSaint Patrick's[email protected]12177142944SAINT JOSEPHIL10Peoria, IL
2022-11-18MelissaReinhartSt. Joseph, Freeburg[email protected]6189792412FREEBURGIL19Belleville Dioecese
2022-11-17MichaelCaseyChurch of St William[email protected]7635715600FridleyMN10St Paul and Minneapolis
2022-11-15LauraHackYouth Life KY - Good Shepherd & Ss. Francis and John[email protected]502-227-4511FrankfortKY19Lexington
2022-11-07KrystynaWojcik-MajkaSt. John Brebeuf[email protected]847-966-8145Niles ILIL14Chicago
2022-11-07AubriBourgeSt. Mary's Sycamore[email protected]3098267709SycamoreIL16Rockford
2022-10-27KatiePylesSt Gall Catholic Church[email protected]815-761-5496ElburnIL8Rockford
2022-10-24MelissaMontenegroChrist the King[email protected]5099461675RichlandWA32Yakima
2022-10-06JulieWieleba-MilkieSacred Heart Parish[email protected]3139106840DearbornMI14Detroit
2022-10-05NickRadunzMary of the Visitation[email protected]3202905578BeckerMN30St. Cloud
2022-10-05MartaRobakSt. Zachary Parish[email protected]8479561264Des PlainesIL15Chicago
2022-10-05MaryWilkersonDivine Child[email protected]313) 562-1990DearbornMI14Archdiocese of Detroit
2022-10-05DawnRoeschSt. Joseph the Worker[email protected]2178994334ChathamIL30Springfield

Total quantity sold : 315

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Camper Paperwork (AKA Applications)

Participant NameNicknameParish / GroupHave you attended CHWC before?How many years?GenderShirt SizeAge Category (at the time of camp)Grade entering in the fall of 2023Cell PhoneEmailFirst Choice Service AssignmentSecond Choice Service AssignmentConstruction: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 CampParticipant Date of BirthEmergency ContactEmergency Contact, Relationship to ParticipantEmergency Contact, Phone NumberHealth Status: Please list any health problems you may havePlease list all medications taken routinely (over the counter and prescription)Physician NamePhysician Phone NumberDate of your last Tetanus BoosterHealth Insurance: ProviderHealth Insurance: Policy NumberHealth Insurance: Group NumberRELEASE OF ALL CLAIMSMEDIA WAIVERCODE OF BEHAVIORParticipant SignatureCustodial Parent NameCustodial Parent SignatureCustodial Parent EmailSIGNATURE AGREEMENTAre you a member of clergy or professed religious?Please SpecifyEntry IDSequence NumberEntry DateDelete Entry Link
Tate Ruzauskas
Christ the King
No
Male
Medium
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)
2
1
2
3
1
1
No
01/03/2007
Gregory Ruzauskas
Dad
(509) 366-0740
None
Mulitvitamins, occasionally ibuprofen
Javier Huerta
(509) 946-1695
02/06/2019
BC/BS
T7M5637694AB
212097
AGREE
AGREE
AGREE
Sarah Ruzauskas
AGREE
338
1
Sarah Ruzauskas
Christ the King
No
Female
Medium
Adult (21 and older)
(509) 967-0184
Work project (painting, indoor clean up, maintenance, repair work, outdoor yard work)
Work at a social service center (homeless shelter, food distribution center)
4
1
3
4
1
1
No
10/07/1976
Gregory Ruzauskas
husband
(509) 366-0740
None
Bystolic, citalopram, lisinopril, mulitvitamins, methylfolate
Dr. Javier Huerta
(509) 946-1695
06/06/2019
BC/BS
T7M5637694AB
212097
AGREE
AGREE
AGREE
AGREE
No
337
2
Isabella Morgan
Bella
St. Joseph, Freeburg
Yes
2
Female
Medium
Youth (under 18)
10th
Work with children at day care centers for low-income families
Work at a social service center (homeless shelter, food distribution center)
1
1
1
1
1
1
no
11/09/2007
Amanda Morgan
Mother
(618) 410-4762
none
none
Dr. Santos
(618) 219-8634
01/14/2022
United Healthcare
929056207
2K6290
AGREE
AGREE
AGREE
Amanda Morgan
AGREE
290
3
Olivia Morgan
Livy or Liv
St. Joseph, Freeburg
Yes
1
Female
Small
Youth (under 18)
9th
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
no
06/06/2009
Amanda Morgan
Mother
(618) 410-4762
none
none
Dr. Santos
(618) 219-8634
01/14/2022
United Healthcare
929056207
2K6290
AGREE
AGREE
AGREE
Amanda Morgan
AGREE
289
4
Brayden Schilling
St. Joseph, Freeburg
Yes
1
Male
XL
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)
3
1
2
2
1
1
Lives and works on a farm
None
04/24/2007
Nicki Schilling
Stepmom
(618) 977-4512
IBU as needed 1x200mg
Dr. Kathryn Wade
(618) 235-2311
01/08/2022
United healthcare
97356187302
1448740
AGREE
AGREE
AGREE
Michael Schilling
AGREE
260
5
Bryce Schilling
St. Joseph, Freeburg
No
Male
Large
Youth (under 18)
9th
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
2
2
1
1
Lives and works on a farm
Gets a bloody nose easily but knows how to handle it.
06/29/2009
Nicki Schilling
Stepmom
(618) 977-4512
Bloody nose
IBU 1 200mg as needed
Dr. Kathryn Wade
(618) 235-2311
01/01/2022
United healthcare
97356187303
1448740
AGREE
AGREE
AGREE
Michael Schilling
AGREE
259
6
Oliver Reinhart
Ollie
St. Joseph, Freeburg
Yes
2
Male
Large
Youth (under 18)
9th
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
3
1
1
02/03/2008
Melissa Reinhart
Mother
(618) 979-2412
Dr. Silhavy Santos
(618) 219-8634
06/27/2019
Blue Cross Blue Shield
xof842076357
p37550
AGREE
AGREE
AGREE
Melissa Reinhart
AGREE
256
7
Tim Reinhart
St. Joseph, Freeburg
Yes
2
Male
Large
Adult (21 and older)
(618) 972-8609
Work project (painting, indoor clean up, maintenance, repair work, outdoor yard work)
Work at a social service center (homeless shelter, food distribution center)
4
4
4
4
4
4
I will only be at CHWC through Monday and then have to leave on Tuesday morning for a work trip. However I'll be happy to do whatever is needed on Monday.
In the past I have been a troubleshooter both times.
None.
Troubleshooter: Assist multiple work teams during the week
02/04/1976
Melissa Reinhart
Spouse
(618) 979-2412
None
none
Dr. Steven Pritchett
(618) 566-8810
10/07/2022
Blue Cross Blue Shield of Illinois
xof842076357
p37550
AGREE
AGREE
AGREE
AGREE
No
255
8
Elaina Reinhart
Elaina
St. Joseph, Freeburg
Yes
1
Female
Medium
Youth (under 18)
12th
Work at a social service center (homeless shelter, food distribution center)
Work with children at day care centers for low-income families
2
1
1
4
1
1
12/08/2005
Melissa Reinhart
Mother
(618) 979-2412
Dr. Silhavy & Santos
(618) 219-8634
06/15/2023
Blue Cross Blue Shield
XOF842076357
P37550
AGREE
AGREE
AGREE
Melissa Reinhart
AGREE
254
9
Christopher Hopfinger
St. Joseph, Freeburg
No
Male
Large
Adult (21 and older)
(618) 444-3660
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
3
4
2
3
04/14/1978
Jennifer Hopfinger
Spouse
(618) 444-2626
Dr. Althoff
(618) 539-0067
01/13/2021
BlueCross BlueShield
R58632825
112
AGREE
AGREE
AGREE
AGREE
No
252
10
Melissa Reinhart
St. Joseph, Freeburg
Yes
3
Female
Small
Adult (21 and older)
(618) 979-2412
Work at a social service center (homeless shelter, food distribution center)
Work with children at day care centers for low-income families
2
1
1
3
1
1
Associate Staff: Stay at home base and work behind the scenes with the HEART staff. 
03/07/1976
Tim Reinhart
spouse
(618) 972-8609
none
solifenacin
Rural Family Medicine
(618) 566-8810
01/25/2023
Blue Cross Blue Shield
xof842076357
p37550
AGREE
AGREE
AGREE
AGREE
No
242
11
Melissa Montenegro
Christ the King
Yes
4
Female
Small
Adult (21 and older)
(509) 392-1050
Work with children at day care centers for low-income families
Work at a social service center (homeless shelter, food distribution center)
1
1
1
2
1
1
12/30/1981
Jean Rieb
Friend
(509) 531-5154
Paul Maiocco, PA
(509) 300-0150
06/21/2022
TPSC
462700302
46270
AGREE
AGREE
AGREE
AGREE
No
213
12