Group List
Total quantity sold : 182 Date Billing First name Billing Last name Billing Company Billing E-mail Billing Phone Billing City Billing State Variation Order Qty Total _billing_diocese 2023-01-17 Quinn Furnald Notre Dame of Mt. Carmel [email protected] 9087970170 Cedar Knolls NJ 15 Paterson 2023-01-09 Angela Seman Holy Spirit Parish [email protected] 724-657-7937 New Castle PA 7 Pittsburgh 2022-12-28 Dan Doyle St Anne-St Patrick [email protected] 5083479353 Fiskdale MA 11 Worcester 2022-10-12 Susan Gallivan St. Richard Parish [email protected] 9784228881 Sterling MA 8 Worcester 2022-10-06 Courtney Callanan The Holy Rood Collaborative [email protected] 978-256-2374 N. Chelmsford MA 17 Boston 2022-10-05 Rebecca Grant Jenkins Our Lady Queen of Peace Catholic Church [email protected] 7039795580 Arlington VA 18 Arlington 2022-10-05 Sarah Beaver Our Lady of Peace [email protected] 8148066041 Erie PA 34 Erie 2022-10-05 Jennifer Frericks St. Jude Parish [email protected] 2174989197 Rochester IL 16 Springfield Illinois 2022-10-05 Robert Ferretti St. Joseph's Parish (NJ) [email protected] 9177102051 Hillsborough NJ 36 Metuchen 2022-10-03 Fr. Paul Castellani St. Philomena [email protected] 2158015434 Lansdowne PA 20 Philadelphia
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 |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
I am completing this Verification Form for my _______________ | Camp Attending | Name of Parish | Name of Group | Please list the names of all adults attending (18+ at the time of camp) | Verification Agreement: Parish | Verification Agreement: Community | Contact Leaders Name | Contact Leader's Signature | Contact Leader's Email | Pastor's Name | Pastor's Signature | Are there any policies your group must follow as established by your diocese? | Please explain | Entry ID | Sequence Number | Entry Date | Delete Entry Link |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Name | Camp (City) Attending | Church/Parish | Comments | Please upload your letter of suitability below | Entry ID | Sequence Number | Entry Date | Delete Entry Link | |
---|---|---|---|---|---|---|---|---|---|
Name | Nickname | Gender | Age Category (at the time of camp) | Grade entering in the fall of 2023 | Cell Phone | 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 | Participant Signature | Custodial Parent Name | Custodial Parent Signature | Custodial Parent Email | SIGNATURE AGREEMENT | Are you a member of clergy or professed religious? | Please Specify | Parish / Group | Camp | Entry ID | Sequence Number | Entry Date | Delete Entry Link |
---|
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 | |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Via Louisville (AKA Applications)
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 | |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|