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
2023-01-11CarinaGreicoSt. Petronille[email protected]630-469-04042106Glen EllynIL10Joliet
2022-12-06KenSkiltonDivine Word[email protected]440-796-8689MentorOH12Cleveland
2022-11-14KellieZahnSt. Rose[email protected]7158539624ClintonvilleWI6Green Bay
2022-10-12JoshGredysRegis Middle School[email protected]319-550-6678Cedar RapidsIA30Archdiocese of Dubuque
2022-10-06GraceCurtisGood Shepherd[email protected]5134898815CincinnatiOH10Cincinnati
2022-10-05DebraBradenHoly Family Parish[email protected]9207562535BrillionWI10Green Bay Diocese
2022-10-05PaulaCaylorSt. Lawrence Catholic Church[email protected]6182670097GreenvilleIL25Springfield IL
2022-10-05ElizabethPostSt. Pius X[email protected]616-460-4962GrandvilleMI30Grand Rapids, MI
2022-10-05JohnTriscikSt. Joan of Arc[email protected]7176023270HersheyPA14Harrisburg
2022-10-05JacquelineGuilbeaultSt. John The Baptist[email protected]920-892-6015PlymouthWI18Milwaukee
2022-10-05ChristyGruenbaumOur Lady of the Presentation[email protected]8162511107Lees SummitMO22Kansas City - St. Joseph
2022-10-04BeckyKrillSt. Mary[email protected]4192983228EdgertonOH29Toledo
2022-10-04KevinSeibertSt Peter[email protected]5672391316ArchboldOH14Toledo
2022-10-03AnitaVan ZileOur Lady of Mercy[email protected]4192373019FayetteOH12Toledo

Total quantity sold : 242

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
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
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
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
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