Group List
Total quantity sold : 320 Date Billing First name Billing Last name Billing Company Billing E-mail Billing Phone Billing City Billing State Variation Order Qty Total _billing_diocese 2023-05-09 Robbie Anderson St. Thomas More Parish (FL) [email protected] 708-476-8306 Sarasota FL 6 Diocese of Venice in Florida 2022-12-30 Chrissy Bundrick Our Lady Star of the Sea [email protected] 9125527783 St. Marys GA 15 Diocese of Savannah 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 Evelyn Fuller St. Matthew [email protected] 908-910-9099 Tyrone GA 8 Atlanta 2022-10-05 Kathleen Ely St. Mary's - Bloomington, IL [email protected] 309-212-5075 Normal IL 30 Peoria, IL 2022-10-05 Michele Eickman St. Mary's Catholic Church (GA) [email protected] 6412952194 Rome GA 28 Atlanta 2022-10-05 Anne Joyce Reading Catholic Collaborative [email protected] 7814248904 Reading MA 13 Boston 2022-10-05 Katie Kelly St. Michael Catholic Church [email protected] 952-447-9056 Prior Lake MN 55 St. Paul & Minneapolis 2022-10-05 Bethanne Maus-Schaefer St. Leonard Catholic Church [email protected] 262-679-0880 Muskego WI 25 Milwaukee 2022-10-05 Kristin Hauser St. Thomas More (NC) [email protected] 919-942-6240 Chapel Hill NC 25 Raleigh 2022-10-01 Gail Watson St. Charles Borromeo [email protected] 8284132840 Morganton NC 30 Charlotte
| 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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St. Matthew – Via Charleston
| 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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St. Mary’s – Via Charleston
| 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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