Group List
Total quantity sold : 368 Date Billing First name Billing Last name Billing Company Billing E-mail Billing Phone Billing City Billing State Variation Order Qty Total _billing_diocese 2022-12-14 Patty McCarthy Holy Family [email protected] 8479073439 Inverness IL 18 Chicago 2022-12-13 Nicole Wellington St. Michael [email protected] 6053611600 Sioux Falls SD 10 Sioux Falls 2022-10-26 Sergio Cortes Lacayo The Epiphany of the Lord Parish [email protected] 814-336-1112 Meadville PA 11 Diocese of Erie 2022-10-26 Christina Hudson St. James [email protected] 2243457214 Arlington Heights IL 30 Chicago 2022-10-21 Jack Novak St. Lawrence [email protected] 5867315072 Utica MI 17 Detroit 2022-10-18 Cari Hall St. Simon Catholic Church [email protected] 812-360-3755 Indianapolis IN 12 Indianapolis 2022-10-10 Gabe Horrall St. Francis Xavier [email protected] 8128913684 Vincennes IN 18 Evansville 2022-10-05 Debra Surmin St. Katharine Drexel [email protected] 630-466-0303 Sugar Grove IL 10 Rockford 2022-10-05 Mark Hawkins The Church of Holy Apostles [email protected] 8153854254 McHenry IL 40 Rockford, IL 2022-10-05 Kristi Sandschafer Tri-Parish CYM [email protected] 2179942754 Newton IL 33 Belleville 2022-10-05 Maureen Rotramel St John XXIII [email protected] 262-284-2102 Port Washington WI 34 Milwaukee 2022-10-05 Sarah Nedved Mary Our Lady of Peace [email protected] 3099483004 Coal Valley IL 14 Peoria 2022-10-04 Jeff Kieffer Our Lady of the Lake [email protected] 217-586-5153 Mahomet IL 28 Peoria, Illinois 2022-10-04 Jodie Blindauer Sacred Heart of Jesus - McCartyville [email protected] 419-236-1615 Anna OH 21 Cincinnati 2022-10-04 Stacie Lamm St. Augustine [email protected] 4198520229 Minster OH 37 Cincinnati 2022-10-02 Krista Falcone Saint Elizabeth Ann Seton [email protected] 765-962-3902 Richmond IN 35 Indianapolis, IN
| 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 | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
William Reiss | Billy | St John XXIII | No | Male | Medium | 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 | This will be Billy’s 2nd year at Workcamp so he has experience from last year working on repairing homes | None | 05/10/2007 | Jennifer Reiss | Mom | (262) 787-8301 | David Meuler | (262) 240-9744 | 06/01/2018 | United Healthcare | 997766609 | 902854 | AGREE | AGREE | AGREE | Jennifer Reiss |  | AGREE | 357 | 1 | January 28, 2023 12:05 AM | |||||||||||
Michael Younger | St John XXIII | No | Male | Large | Adult (21 and older) | (262) 212-3202 | Work project (painting, indoor clean up, maintenance, repair work, outdoor yard work) | Work project (painting, indoor clean up, maintenance, repair work, outdoor yard work) | 5 | 2 | 3 | 5 | 4 | 4 | Hands-on Electrical Engineer. Deep experience in carpentry, plumbing, HVAC. Long-term site coach with Group WC’s. | None | Troubleshooter: Assist multiple work teams during the week | 01/15/1962 | Machele Younger | Spouse | (262) 370-0775 | Healthy | None | Mark D. Shewczyk | (262) 376-1934 | 01/15/2019 | United Healthcare | 943120359 | 716850 | AGREE | AGREE | AGREE |  | AGREE | No | 285 | 2 | January 24, 2023 10:48 AM | |||||||||
Sheri Hanson | St John XXIII | No | Female | Medium | Adult (21 and older) | (262) 825-6536 | Work at a social service center (homeless shelter, food distribution center) | Work with children at day care centers for low-income families | 2 | 1 | 1 | 3 | 1 | 1 | I have asthma and use an inhaler, but it would help if I wasn't around smokers, lots of dust and other allergens. | Associate Staff: Stay at home base and work behind the scenes with the HEART staff. | 04/26/1976 | Robert Wheeler | Husband | (262) 825-6591 | Asthma | Inhaler Allegy medicine (over the counter, Allertec) | Aurora Cedar Creek | (262) 375-3700 | 10/16/2017 | UMR | 13047099 | 76-040178 | AGREE | AGREE | AGREE |  | AGREE | No | 272 | 3 | January 23, 2023 5:32 PM | ||||||||||
Maureen Rotramel | St John XXIII | Yes | 15 | Female | 3XL | Adult (21 and older) | (414) 324-9131 | Work at a social service center (homeless shelter, food distribution center) | Work with children at day care centers for low-income families | 2 | 1 | 1 | 3 | 1 | 1 | I have been on enough trips that I am fine not being with a work group if you need help in other areas... | Cannot do stairs or ladders because of bad knees | Associate Staff: Stay at home base and work behind the scenes with the HEART staff. | 12/19/1969 | John Rotramel | Husband | (414) 801-7050 | Sleep apnea, arthritis in knees, migraines, seasonal allergies | Lipitor - 10mg/day for cholesterol Quilipta - 60mg/day for migraines Xyzal daily for seasonal allergies Ibuprofen as needed | Dr. Jeffrey Reichel | (414) 771-8228 | 06/12/2017 | United Health Care | 967730746 | 712332 | AGREE | AGREE | AGREE |  | AGREE | No | 245 | 4 | January 20, 2023 5:39 PM | ||||||||
Trinity Semler | Saint Elizabeth Ann Seton | No | Female | Medium | Adult (21 and older) | (765) 238-5563 | Work with children at day care centers for low-income families | Work project (painting, indoor clean up, maintenance, repair work, outdoor yard work) | 2 | 1 | 1 | 3 | 1 | 1 | 05/22/2000 | Chad Semler | Father | (630) 450-7477 | Allergy: Penicillin | Bonnie Allen | (765) 935-8581 | 08/10/2020 | Blue Cross Blue Shield | ITS | ITSM6134955702 | AGREE | AGREE | AGREE |  | AGREE | No | 237 | 5 | January 20, 2023 12:28 PM | |||||||||||||
James Miller | Jim | Saint Elizabeth Ann Seton | Yes | 9 | Male | XL | Adult (21 and older) | (765) 914-4466 | Work project (painting, indoor clean up, maintenance, repair work, outdoor yard work) | Work at a social service center (homeless shelter, food distribution center) | 2 | 1 | 2 | 4 | 1 | 1 | As a Deacon, I am willing to be assigned any duties that will help the Camp be a success. | None | 06/08/1954 | Evelyn Miller | Wife | (765) 914-4465 | None | Aspirin 81mg Atorvastatin 20mg Amlodipine Besylate 5mg | Dr. Jennifer Olsen | (765) 935-4088 | 11/11/1964 | Medicare | 4DA9-MV0-HY40 | N/A | AGREE | AGREE | AGREE |  | AGREE | Yes | Deacon | 229 | 6 | January 19, 2023 10:15 PM |