Group List
Total quantity sold : 342 Date Billing First name Billing Last name Billing Company Billing E-mail Billing Phone Billing City Billing State Variation Order Qty Total _billing_diocese 2022-11-22 Jacob Peterson St. James [email protected] 12317369420 Montague MI 10 Grand Rapids 2022-10-17 David Campo Our Lady Comforter of the Afflicted [email protected] 8572512372 Waltham MA 15 Boston 2022-10-05 Debbi Koeberlein St Thomas/St Mary's [email protected] 2173692641 Philo IL 60 Peoria Illinois 2022-10-05 Michele Eickman St. Mary's Catholic Church [email protected] 6412952194 Rome GA 30 Atlanta 2022-10-05 Anne Joyce Reading Catholic Collaborative [email protected] 7814248904 Reading MA 20 Boston 2022-10-05 Sarai Myers St. Edward [email protected] 713-979-6831 Spring TX 28 Galveston Houston 2022-10-05 Katie Kelly St. Michael Catholic Church [email protected] 952-447-9056 Prior Lake MN 74 St. Paul & Minneapolis 2022-10-05 Bethanne Maus-Schaefer St. Leonard Catholic Church [email protected] 262-679-0880 Muskego WI 40 Milwaukee 2022-10-05 Kristin Hauser St. Thomas More [email protected] 919-942-6240 Chapel Hill NC 25 Raleigh 2022-10-01 Gail Watson St. Charles Borromeo [email protected] 8284132840 Morganton NC 40 Charlotte
| 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 | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Joseph Sher | St. Michael Catholic Church | Yes | 1 | Male | Medium | Young Adult (18-20) | (612) 759-9585 | Work project (painting, indoor clean up, maintenance, repair work, outdoor yard work) | Work with children at day care centers for low-income families | 2 | 1 | 1 | 4 | 1 | 1 | 11/09/2004 | Karen Sher | Mother | (612) 965-2736 | Dr. Rob Leher | (952) 226-2600 | 07/25/2017 | Blue Cross Blue Shield | JZH132961866001 | 10778450 | AGREE | AGREE | AGREE |  | AGREE | No | 292 | 1 | January 24, 2023 10:17 PM | |||||||||||||
Keaton Daniel | St. Michael Catholic Church | No | Male | Medium | Youth (under 18) | 12th | Work project (painting, indoor clean up, maintenance, repair work, outdoor yard work) | Work with children at day care centers for low-income families | 1 | 1 | 1 | 2 | 1 | 1 | 02/14/2006 | Jason Daniel | Dad | (952) 412-9040 | Type 1 Diabetes | Insulin | Brandon Nathan | (952) 237-4694 | 09/13/2018 | Cigna | U21989822 | 3341246 | AGREE | AGREE | AGREE | Andrea Daniel |  | AGREE | 287 | 2 | January 24, 2023 11:17 AM |