Group List

Date Billing First name Billing Last name Billing Company Billing E-mail Billing Phone Billing City Billing State Variation Order Qty Total _billing_diocese
2022-10-24AllisonSteen-BakerHoly Spirit (Bowling Green KY)[email protected]2708427777BOWLING GREENKY11Owensboro, KY
2022-10-05AbbyWalravenSt. Rita[email protected]5174999539JacksonMI10Lansing
2022-10-05ArielleJoaquinOur Lady of the Wayside[email protected]8473508008Arlington HeightsIL12Archdiocese of Chicago
2022-10-05AmyHodsonSt Anne[email protected]847-620-3073BarringtonIL14Archdiocese of Chicago
2022-10-05TimothySchosserSt. Elizabeth Ann Seton[email protected]8595364648LexingtonKY16Lexington
2022-10-05DarciMillsSt. Michael Church[email protected]630-462-5044WheatonIL21Diocese of Joliet
2022-10-05SarahBeaverOur Lady of Peace[email protected]8148066041EriePA30Erie
2022-10-05StephanieBeaverSt. Joseph, East Bristol[email protected]6083457203Fall RiverWI10Madison
2022-10-05NinoRebholzThree Holy Women[email protected]414-271-6577MilwaukeeWI14Archdiocese of Milwaukee
2022-10-05MariaKingerySt. Francis church[email protected]217-961-1500TeutopolisIL48Springfield, IL
2022-10-05BennettDianoSt. Luke Catholic Church[email protected]2057920930TempleTX36Austin
2022-10-05KaylaGreinerSt. Cecilia[email protected]515-232-3514AmesIA25Dubuque
2022-10-05MaureenRossSt. Theresa[email protected]847-276-0005PalatineIL11Chicago
2022-10-05BethO'SullivanMary, Queen of the Holy Rosary[email protected]440-479-5302LexingtonKY27Lexington, KY
2022-10-05JackTuinierChrist the King[email protected]812-367-1212FerdinandIN15Evansville
2022-10-05CindyCaughmanSt Francis of Assisi[email protected]1770382454912cartersvilleGA15atlanta
2022-10-03JillOrbanCatholic Church of St. Ann[email protected]6785958231MariettaGA28Atlanta

Total quantity sold : 343

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Camper Paperwork (AKA Applications)

Participant NameNicknameParish / GroupHave you attended CHWC before?How many years?GenderShirt SizeAge Category (at the time of camp)Grade entering in the fall of 2023Cell PhoneEmailFirst Choice Service AssignmentSecond Choice Service AssignmentConstruction: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 CampParticipant Date of BirthEmergency ContactEmergency Contact, Relationship to ParticipantEmergency Contact, Phone NumberHealth Status: Please list any health problems you may havePlease list all medications taken routinely (over the counter and prescription)Physician NamePhysician Phone NumberDate of your last Tetanus BoosterHealth Insurance: ProviderHealth Insurance: Policy NumberHealth Insurance: Group NumberRELEASE OF ALL CLAIMSMEDIA WAIVERCODE OF BEHAVIORParticipant SignatureCustodial Parent NameCustodial Parent SignatureCustodial Parent EmailSIGNATURE AGREEMENTAre you a member of clergy or professed religious?Please SpecifyEntry IDSequence NumberEntry DateDelete Entry Link
Paulette Orf
Paula
St. Luke Catholic Church
Yes
1
Female
Large
Adult (21 and older)
(254) 760-3330
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
3
1
1
Exceptional attention to details, leader/organizer, and willing to work where needed.
None
Associate Staff: Stay at home base and work behind the scenes with the HEART staff. ,Troubleshooter: Assist multiple work teams during the week
01/09/1975
Terry Orf
Spouse
(254) 760-5068
None
Zyxal, ibprofen, decongestant when needed. Daily vitamins
Dr. Leslie Barkis
(254) 298-2400
08/07/1987
Independence Personal Choice (BCBS)
No policy number
YXF126460123001
AGREE
AGREE
AGREE
AGREE
No
352
1