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
2022-10-07JosephKuschelSt. Bridget of Sweden Catholic Church[email protected]651257247456LindstromMN14Saint Paul / Minneapolis
2022-10-05CorinnaRamseyGood Shepherd and St. James Catholic Churches[email protected]2623453897Menomonee FallsWI55Milwaukee
2022-10-05DiannTimmermanOur Lady of the Prairie - St. Mary's/St. Michael's[email protected]507-629-4075TracyMN24New Ulm
2022-10-05MonicaLohmullerSW Newton & Benton County Pastorate (SWNBC Pastorate)[email protected]7654302117OxfordIN27Lafayette-in-Indiana
2022-10-05CarolBrunsEpiphany Parish (IA)[email protected]6414235001Mason CityIA17Archdiocese of Dubuque
2022-10-05MikeLiftoSt. Francis of Assisi[email protected]715-273-4774EllsworthWI29La Crosse
2022-10-05TammyHouleSt. Catherine's Catholic Churc[email protected]507-644-2278Redwood FallsMN20New Ulm
2022-10-05TaylorBaarSt. Anthony on the Lake Parish[email protected]262-691-9170PewaukeeWI18Milwaukee Archdiocese
2022-10-05KaraEskerEpiphany Catholic Church (IL)[email protected]2178214801NormalIL42Peoria, IL
2022-10-05PaulVan LysebettensOur Lady of the Blessed Sacrament (f/k/a St. Julian Eymard & Queen of the Rosary Churches)[email protected](847) 979-0901Elk Grove VillageIL12Archdiocese of Chicago
2022-10-05ErinEricksonCatholic Community of Waukesha[email protected]2625476555WaukeshaWI20Milwaukee

Total quantity sold : 278

Email selected customers

Contact Leader's NameParish/Youth GroupCamp AttendingVehicle 1 - Type of VehicleVehicle 1 - Driver's NameVehicle 1 - Insurance CompanyVehicle 1 - Number of SeatbeltsAdd second vehicle?Vehicle 2 - Type of VehicleVehicle 2 - Driver's NameVehicle 2 - Number of SeatbeltsVehicle 2 - Insurance CompanyAdd third vehicle?Vehicle 3 - Type of VehicleVehicle 3 - Driver's NameVehicle 3 - Number of SeatbeltsVehicle 3 - Insurance CompanyAdd fourth vehicle?Vehicle 4 - Type of VehicleVehicle 4 - Driver's NameVehicle 4 - Number of SeatbeltsVehicle 4 - Insurance CompanyAdd fifth vehicle? Vehicle 5 - Type of VehicleVehicle 5 - Driver's NameVehicle 5 - Number of SeatbeltsVehicle 5 - Insurance CompanyAdd sixth vehicle?Vehicle 6 - Type of VehicleVehicle 6 - Driver's NameVehicle 6 - Number of SeatbeltsVehicle 6 - Insurance CompanyAdd seventh vehicle?Vehicle 7 - Type of VehicleVehicle 7 - Driver's NameVehicle 7 - Number of SeatbeltsVehicle 7 - Insurance CompanyAdd eighth vehicle?Vehicle 8 - Type of VehicleVehicle 8 - Driver's NameVehicle 8 - Number of SeatbeltsVehicle 8 - Insurance CompanyAdd ninth vehicle?Vehicle 9 - Type of VehicleVehicle 9 - Driver's NameVehicle 9 - Number of SeatbeltsVehicle 9 - Insurance CompanyDeparture Date & TimeDeparture City & CodeDeparture Airline & Flight #Do you have a connecting flight for this trip?Connecting City & CodeConnecting Airline & Flight #Connecting Date / TimeArrival Date & TimeDeparture 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?CommentsContact Leader EmailEntry IDSequence NumberEntry DateDelete Entry Link
Joseph Kuschel
St. Bridget of Sweden
Marshalltown, IA
Minivan
Joseph Kuschel
St. Bridget of Sweden Catholic Church
7
Yes
Mini Van
Charlie Hampton
7
St. Bridget of Sweden Catholic Church
No
No
319
1
No records found
No records found

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
Laura Carlson
St. Bridget of Sweden Catholic Church
Yes
2
Female
XL
Youth (under 18)
11th
Work project (painting, indoor clean up, maintenance, repair work, outdoor yard work)
Work at a social service center (homeless shelter, food distribution center)
1
1
1
2
1
1
I am an athlete, I am strong and a hard worker
01/18/2007
Beth A Carlson
mom
(651) 492-4729
Animal dander, and fur Allergies and seasonal allergies
Daily Allergy Pill
Dr. S. Peterson
(651) 257-8599
06/07/2019
Cigna Health Partners
U7333043203
3329978
AGREE
AGREE
AGREE
Beth Carlson
AGREE
332
1
Linnea Carlson
St. Bridget of Sweden Catholic Church
No
Female
XL
Youth (under 18)
9th
Work project (painting, indoor clean up, maintenance, repair work, outdoor yard work)
Work at a social service center (homeless shelter, food distribution center)
1
1
1
2
1
1
I am an athlete, strong and a hard worker
Allergic to Penicillin, Dyslexia
12/18/2008
Beth Carlson
Mom
(651) 492-4729
Allergic to Penicillin, Dyslexia
Dr. S. Peterson
(651) 257-8499
07/28/2020
Cigna Health Partners
U7333043204
3329978
AGREE
AGREE
AGREE
Beth Carlson
AGREE
331
2
Joseph Kuschel
Joe
St. Bridget of Sweden Catholic Church
Yes
-2
Male
3XL
Adult (21 and older)
(651) 274-1500
Work with children at day care centers for low-income families
Work at a social service center (homeless shelter, food distribution center)
3
2
3
4
2
2
none
05/19/1956
Jill Kuschel
wife
(651) 274-1510
none
niacin, ginger root, allopurinol
Amanda Dubuque
(855) 324-7843
05/14/2014
Blue Cross Blue Shield
JZD126619142001
10191418
AGREE
AGREE
AGREE
AGREE
No
317
3