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
2022-10-25RachelSuggBlessed Sacrament Catholic Church[email protected]757-423-8305NorfolkVAVariation Name:  ROME & ASSISI (July 16-26) - Rome: With Flights
type:  Rome: With Flights
10Richmond, VA
2021-12-15KaylaMohsSt Mary of the Presentation[email protected]2186435443BreckenridgeMNVariation Name:  ROME & ASSISI (July 16-26) - Rome: With Flights
type:  Rome: With Flights
20St Cloud
2021-11-16MicheleLuekeSt. John the Baptist[email protected]6188388208McLeansboroILVariation Name:  ROME & ASSISI (July 16-26) - Rome: With Flights
type:  Rome: With Flights
44Belleville
2021-11-01LisaGroverSt. Ambrose & St. Peter's Church[email protected]802-989-3895BristolVTVariation Name:  ROME & ASSISI (July 16-26) - Rome: With Flights
type:  Rome: With Flights
15Diocese of Burlington Vermont

Total quantity sold : 89

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I am completing this Verification Form for my _______________ Camp AttendingName of ParishName of GroupPlease list the names of all adults attending (18+ at the time of camp)Verification Agreement: ParishVerification Agreement: CommunityContact Leaders NameContact Leader's SignatureContact Leader's EmailPastor's NamePastor's SignatureAre there any policies your group must follow as established by your diocese?Please explainEntry IDSequence NumberEntry DateDelete Entry Link
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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 PhoneEmailOther 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 SpecifyALCOHOL POLICY ACKNOWLEDGMENTPassport NumberEntry IDSequence NumberEntry DateDelete Entry Link
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