Group List
Total quantity sold : 315 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 21 Superior 2023-01-19 Tina Schnarr St. Pius X [email protected] 317-466-3370 Indianapolis IN 8 Indianapolis 2023-01-13 Brian Nilles Church of the Resurrection [email protected] 563-556-7511 Dubuque IA 7 Archdiocese of Dubuque 2023-01-10 Mikayla Anderson St John the Baptist Catholic Church [email protected] 651-633-8333 New Brighton MN 30 St. Paul and Minneapolis 2022-12-30 Fr. Dean Probst St. Thomas [email protected] 618-783-8741 Newton IL 18 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 [email protected] 7635715600 Fridley MN 10 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 8 Rockford 2022-10-24 Melissa Montenegro Christ the King [email protected] 5099461675 Richland WA 32 Yakima 2022-10-06 Julie Wieleba-Milkie Sacred Heart Parish [email protected] 3139106840 Dearborn MI 14 Detroit 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 15 Chicago 2022-10-05 Mary Wilkerson Divine Child [email protected] 313) 562-1990 Dearborn MI 14 Archdiocese of Detroit 2022-10-05 Dawn Roesch St. Joseph the Worker [email protected] 2178994334 Chatham IL 30 Springfield
| 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 | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
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 | January 26, 2023 6:59 PM | |||||||||||
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 | January 26, 2023 6:54 PM | |||||||||||
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 | January 24, 2023 1:13 PM | |||||||||
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 | January 24, 2023 1:10 PM | |||||||||
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 | January 23, 2023 9:07 AM | ||||||||||
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 | January 23, 2023 9:02 AM | ||||||||||
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 | January 22, 2023 8:02 PM | ||||||||||||
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 | January 22, 2023 8:00 PM | ||||||||
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 | January 22, 2023 8:00 PM | ||||||||||||
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 | January 22, 2023 4:50 PM | ||||||||||||||
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 | January 20, 2023 4:53 PM | ||||||||||
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 | January 19, 2023 7:14 PM |