Group List
Total quantity sold : 242 Date Billing First name Billing Last name Billing Company Billing E-mail Billing Phone Billing City Billing State Variation Order Qty Total _billing_diocese 2023-01-11 Carina Greico St. Petronille [email protected] 630-469-04042106 Glen Ellyn IL 10 Joliet 2022-12-06 Ken Skilton Divine Word [email protected] 440-796-8689 Mentor OH 12 Cleveland 2022-11-14 Kellie Zahn St. Rose [email protected] 7158539624 Clintonville WI 6 Green Bay 2022-10-12 Josh Gredys Regis Middle School [email protected] 319-550-6678 Cedar Rapids IA 30 Archdiocese of Dubuque 2022-10-06 Grace Curtis Good Shepherd [email protected] 5134898815 Cincinnati OH 10 Cincinnati 2022-10-05 Debra Braden Holy Family Parish [email protected] 9207562535 Brillion WI 10 Green Bay Diocese 2022-10-05 Paula Caylor St. Lawrence Catholic Church [email protected] 6182670097 Greenville IL 25 Springfield IL 2022-10-05 Elizabeth Post St. Pius X [email protected] 616-460-4962 Grandville MI 30 Grand Rapids, MI 2022-10-05 John Triscik St. Joan of Arc [email protected] 7176023270 Hershey PA 14 Harrisburg 2022-10-05 Jacqueline Guilbeault St. John The Baptist [email protected] 920-892-6015 Plymouth WI 18 Milwaukee 2022-10-05 Christy Gruenbaum Our Lady of the Presentation [email protected] 8162511107 Lees Summit MO 22 Kansas City - St. Joseph 2022-10-04 Becky Krill St. Mary [email protected] 4192983228 Edgerton OH 29 Toledo 2022-10-04 Kevin Seibert St Peter [email protected] 5672391316 Archbold OH 14 Toledo 2022-10-03 Anita Van Zile Our Lady of Mercy [email protected] 4192373019 Fayette OH 12 Toledo
| 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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Debra Braden | Holy Family Parish-Brillion, WI | New Castle, PA | suv | unsure unsure | Holy Family Parish | 7 | Yes | suv | unsure unsure | 7 | Holy Family Parish | No | No | 191 | 1 | January 19, 2023 4:04 PM |
| 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 | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Jacqueline Guilbeault | St. John The Baptist | Yes | 1 | Female | Small | Adult (21 and older) | (847) 224-5453 | 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 | Ankle surgery early 2023, may have some limitations but not sure yet! | Associate Staff: Stay at home base and work behind the scenes with the HEART staff. ,Troubleshooter: Assist multiple work teams during the week | 07/05/1996 | Gerald Guilbeault | Father | (847) 323-9995 | Exercise induced Asthma, Right Ankle Surgery early 2023 | Citalopram - Anxiety - 40mg every night Amitriptyline - headaches - 25mg every night SUMAtriptan - Migraines - 50mg as needed | Elizabeth Devries | (920) 565-4595 | 01/12/2023 | UnitedHealthcare | 989668458 | 712332 | AGREE | AGREE | AGREE |  | AGREE | No | 266 | 1 | January 23, 2023 1:12 PM | |||||||||
Paula Caylor | St. Lawrence Catholic Church | Yes | 5 | Female | XL | Adult (21 and older) | (618) 267-1097 | Work at a social service center (homeless shelter, food distribution center) | Work with children at day care centers for low-income families | 2 | 1 | 2 | 3 | 2 | 2 | I love serving the community. | I have back and neck issues that limit my lifting and bending abilities. I am currently in the process to figure out a reason for weakness in my right arm and hand (my dominant hand). I can only lift about 20 pounds. | 04/28/1981 | Jason Caylor | Spouse | (618) 978-7187 | Lumbar fusion that causes limited movement and limited lifting. Bulging disc in the neck. Still working on how to reduce pain in this area. Possible seizures. I've only had 1 and they aren't positive that's what it was. | Belbuca 600 mcg pain Pregabalin 50 mg & 100 mg nerve pain Nabumatone 500 mg pain Corisoprodol 350 mg pain Levetirsceta 500 mg seizures Omeprazole 20 mg as needed heart hurn Sumatriptan 50 mg migraines Vit b12 Magnesium Potassium Multivitamin | Kelsey Hopkins | (618) 664-1240 | 07/01/1999 | Blue cross blue shield | ODL907765969 | 130445 | AGREE | AGREE | AGREE |  | AGREE | No | 200 | 2 | January 19, 2023 5:13 PM |