Group List
Total quantity sold : 89 Date Billing First name Billing Last name Billing Company Billing E-mail Billing Phone Billing City Billing State Variation Order Qty Total _billing_diocese 2022-10-25 Rachel Sugg Blessed Sacrament Catholic Church [email protected] 757-423-8305 Norfolk VA Variation Name: ROME & ASSISI (July 16-26) - Rome: With Flights
type: Rome: With Flights10 Richmond, VA 2021-12-15 Kayla Mohs St Mary of the Presentation [email protected] 2186435443 Breckenridge MN Variation Name: ROME & ASSISI (July 16-26) - Rome: With Flights
type: Rome: With Flights20 St Cloud 2021-11-16 Michele Lueke St. John the Baptist [email protected] 6188388208 McLeansboro IL Variation Name: ROME & ASSISI (July 16-26) - Rome: With Flights
type: Rome: With Flights44 Belleville 2021-11-01 Lisa Grover St. Ambrose & St. Peter's Church [email protected] 802-989-3895 Bristol VT Variation Name: ROME & ASSISI (July 16-26) - Rome: With Flights
type: Rome: With Flights15 Diocese of Burlington Vermont
| 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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| 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 | 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 | ALCOHOL POLICY ACKNOWLEDGMENT | Passport Number | Entry ID | Sequence Number | Entry Date | Delete Entry Link | |
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