Group List
Total quantity sold : 216 Date Billing First name Billing Last name Billing Company Billing E-mail Billing Phone Billing City Billing State Variation Order Qty Total _billing_diocese 2023-05-02 Liv Schneider Richmond LIGHTs [email protected] 8044500302 Richmond VA 21 Richmond 2022-10-24 Emily Rauser St. Pius X [email protected] 2032556134 Fairfield CT 25 Bridgeport 2022-10-21 Bryanna Urso All Saints (PA) [email protected] 724-287-1759 Butler PA 38 Pittsburgh 2022-10-05 Michele McPheely Immaculate Heart of Mary [email protected] 812-454-7143 Atlanta GA 28 Archdiocese of Atlanta 2022-10-05 Lynn Pechiney All Saints (VA) [email protected] 7033932141 Manassas VA 62 Arlington 2022-10-05 Katie Boosel Northern Butler County Catholic Churches [email protected] 7249531669 Slippery Rock PA 12 Pittsburgh 2022-10-04 Michele Lanuti Mother Teresa Catholic Church [email protected] 919-656-9979 Cary NC 30 Diocese of Raleigh, N.C
| 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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| 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 |
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| Name | Camp (City) Attending | Church/Parish | Comments | Please upload your letter of suitability below | Entry ID | Sequence Number | Entry Date | Delete Entry Link |
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| 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 Status | Entry Author | Entry Resume Link | Delete Entry Link | |
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