Group List
Total quantity sold : 389 Date Billing First name Billing Last name Billing Company Billing E-mail Billing Phone Billing City Billing State Variation Order Qty Total _billing_diocese 2022-11-15 Diana Loutsch St. Edward [email protected] 9528357101 Bloomington MN 21 Archdiocese of St. Paul and Minneapolis 2022-11-15 John Powen Holy Cross Parish Community Room or via Zoom [email protected] 708-906-5802 Deerfield IL 20 Archdiocese of Chicago 2022-11-14 Sarah Casey St. Elizabeth Ann Seton [email protected] 3193933778 HIAWATHA IA 14 Archdiocese of Dubuque 2022-11-14 Tracy Stocker St. John XXIII Parish (IA) [email protected] 13198463139 Cedar Rapids IA 22 Dubuque 2022-11-14 Deacon Jim Novak Sacred Heart Catholic Church [email protected] 940-889-5252 Seymour TX 12 Fort Worth, Tx. 2022-11-10 Maria Haas Saints John and Paul Parish [email protected] 5635068711 Altoona IA 10 Des Moines 2022-11-04 Alex Quiñones St. Ignatius [email protected] 281-290-4623 Spring TX 35 Galveston-Houston 2022-10-25 Claire Parrulli-Lowther St. John XXIII (NM) [email protected] 5053232750 Albuquerque NM 20 Santa Fe 2022-10-13 Jocelyn Johnson Our Lady of Peace [email protected] 3202507319 Minneapolis MN 10 St. Paul & Minneapolis 2022-10-05 Katie Dell St. Jude [email protected] 2149442087 Allen TX 16 Dallas 2022-10-05 Wendy Wandro Immaculate Conception [email protected] 6412281071 Charles City IA 30 Dubuque 2022-10-05 Tyler Ried St. Alexander [email protected] 3098262049 Palos Heights IL 16 Chicago 2022-10-05 Deb Malcom Church of St. Benedict [email protected] 918-455-4451 Broken Arrow OK 30 Tulsa 2022-10-05 John Sobol St. Elizabeth Seton and St. Stephen Deacon and Martyr [email protected] 708-986-2446 Orland Hills IL 16 Archdiocese of Chicago 2022-10-05 Katie Smith St. Joseph [email protected] 9792551684 Richardson TX 25 Dallas 2022-10-05 Catherine Campbell St. Columbkille [email protected] 402-339-3285 Papillion NE 36 Archdiocese of Omaha 2022-10-05 Jim Welch St. Mary of Vernon [email protected] 224-531-7454 Indian Creek IL 26 Chicago 2022-10-03 Evelyn Garfias St. Walter [email protected] 6304415036 Roselle IL 25 Joliet 2022-10-03 Connie Brunswick St NIcholas [email protected] 9376233865 Osgood OH 5 Cincinnati
| 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 | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Jocelyn Johnson | Our Lady of Peace | Yes | 5 | Female | Medium | Adult (21 and older) | (320) 250-7319 | Work at a social service center (homeless shelter, food distribution center) | Work project (painting, indoor clean up, maintenance, repair work, outdoor yard work) | 2 | 1 | 1 | 3 | 1 | 1 | 07/11/1994 | Tracy Johnson | mother | (320) 290-2847 | seasonal allergies, allergy-induced asthma, hypothyroidism, endometriosis | levothyroxine, 25mg/day, hypothyroidism progesterone, 200mg/day 10 days/month, endometriosis naproxen (as needed for endometriosis/menstrual cramps) antihistamine (as needed for seasonal allergies) albuterol inhaler (as needed for allergy-induced asthma) | Cheryl McKee | (651) 653-0062 | 10/23/2013 | Blue Cross Blue Shield | JZH133421246001 | 10292561 | AGREE | AGREE | AGREE |  | AGREE | No | 321 | 1 | January 26, 2023 11:57 AM | |||||||||||
Daniel Nitz | Daniel | St. Mary of Vernon | Yes | 1 | Male | Large | Youth (under 18) | 11th | Work with children at day care centers for low-income families | Work at a social service center (homeless shelter, food distribution center) | 2 | 1 | 1 | 2 | 1 | 1 | N/A | N/A | 07/03/2007 | Christine Nitz | Mother | (847) 602-2497 | seasonal allergies. prescription for ADHD & general anxiety. | Dexmethylphenidate* 20mg (aka Focalin) Sertraline 50 mg (aka Zoloft) Guanfacine 3mg (aka Intuniv) seasonal allergy medicine like "Claritin" | Dr. Dimple Damani c/o Pediatric Partners | (847) 362-4155 | 08/23/2018 | Blue Cross Blue Shield | LJX835968699 | 256922 | AGREE | AGREE | AGREE | Christine Nitz |  | AGREE | 234 | 2 | January 20, 2023 11:25 AM |