Group List
Total quantity sold : 273 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 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 15 Des Moines 2022-10-25 Claire Parrulli-Lowther St. John XXIII (NM) [email protected] 5053232750 Albuquerque NM 12 Santa Fe 2022-10-13 Jocelyn Johnson Our Lady of Peace [email protected] 3202507319 Minneapolis MN 6 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 20 Dubuque 2022-10-05 Tyler Ried St. Alexander [email protected] 3098262049 Palos Heights IL 12 Chicago 2022-10-05 Deb Malcom Church of St. Benedict [email protected] 918-455-4451 Broken Arrow OK 16 Tulsa 2022-10-05 John Sobol St. Elizabeth Seton and St. Stephen Deacon and Martyr [email protected] 708-986-2446 Orland Hills IL 4 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 35 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 15 Joliet 2022-10-03 Connie Brunswick St NIcholas [email protected] 9376233865 Osgood OH 3 Cincinnati
| 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 |
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| 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 |
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| Name | Camp (City) Attending | Church/Parish | Comments | Please upload your letter of suitability below | Entry ID | Sequence Number | Entry Date | Delete Entry Link |
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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 | |
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