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
2022-11-07TimMcNamaraSt. Martin of Tours[email protected]269-420-4233VicksburgMI15Kalamazoo
2022-10-17AshleyArcherSacred Heart - Cut Off[email protected]985-291-4711Cut OffLA18Houma-Thibodaux
2022-10-13AnthonyBeauregardSaint Therese Catholic Church[email protected]8593120134MooresvilleNC20Diocese of Charlotte, NC
2022-10-06VictoriaReevesSt. Anna's[email protected]770-267-7637MonroeGA20Atlanta, GA
2022-10-05JenniferChellbergNativity Catholic Church[email protected]407-322-3961LongwoodFL20Orlando
2022-10-05TracyJeddSt. Eugene Church[email protected]8282545193AshevilleNC26Charlotte
2022-10-05MaryUjdaMarist School[email protected]7709362263AtlantaGA24Atlanta
2022-10-04AnnieNassisAll Saints Catholic Church[email protected]8654748609KNOXVILLETN24Knoxville

Total quantity sold : 167

Email selected customers

No records found
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
Bonny Louviere
Sacred Heart - Cut Off
No
Female
XL
Adult (21 and older)
(985) 772-9023
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
No health issues
Associate Staff: Stay at home base and work behind the scenes with the HEART staff. ,Troubleshooter: Assist multiple work teams during the week
04/22/1969
Peter Louviere
Husband
(985) 691-0265
No health problems
Spironolactone 25 mg 3 QD
Estroven 1 QD
Caltrate 600 mg QD
Potassium 99 mg QD
Magnesium 250 mg QD
Centrum Silver Women’s +50
B12 500 mcg QD
Aspirin 81 mg QD
Osteo Bi-Flex QD
D3 25 mcg (1000 IU) QD
Amanda Rogers
(985) 798-7000
05/08/2015
Blue Cross Blue Shield of Louisiana
XUP201279066
78D05ERC/0000
AGREE
AGREE
AGREE
AGREE
No
366
1
Luke Louviere
Sacred Heart - Cut Off
No
Male
Small
Youth (under 18)
10th
Work project (painting, indoor clean up, maintenance, repair work, outdoor yard work)
Work at a social service center (homeless shelter, food distribution center)
4
1
3
3
2
3
No health issues noted
07/20/2008
Bonny Louviere
Mother
(985) 772-9023
No health problems
None
E. Gisclair, NP
(985) 632-6233
05/08/2015
Blue Cross Blue Shield of Louisiana
XUP201279066
78D05ERC/0000
AGREE
AGREE
AGREE
Bonny Louviere
AGREE
364
2
Louviere Evan
Sacred Heart - Cut Off
No
Male
Small
Youth (under 18)
12th
Work project (painting, indoor clean up, maintenance, repair work, outdoor yard work)
Work at a social service center (homeless shelter, food distribution center)
3
1
1
3
1
1
No health issues to date
10/15/2005
Bonny Louviere
Mother
(985) 772-9023
No health problems
None
E. Gisclair, NP
(985) 632-6233
08/08/2017
Blue Cross Blue Shield of Louisiana
XUP201279066
78D05ERC/0000
AGREE
AGREE
AGREE
Bonny Louviere
AGREE
363
3
Ashley Archer
Sacred Heart - Cut Off
No
Female
XL
Adult (21 and older)
(985) 291-4711
Work with children at day care centers for low-income families
Work at a social service center (homeless shelter, food distribution center)
1
1
1
3
1
1
I don't mind learning new things.
12/21/1958
Al Archer
spouse
(985) 696-9222
problem with knee, had a knee replacement (right)
Atorvastatin 10mg
Lumigan 0.01%
Daily vitamin
Immune 24
Dwight Matherne
(985) 632-6233
03/15/2018
Blue Cross
GAL931767910686
GAL931767910686
AGREE
AGREE
AGREE
AGREE
No
361
4