Group List
Total quantity sold : 76 Date Billing First name Billing Last name Billing Company Billing E-mail Billing Phone Billing City Billing State Variation Order Qty Total _billing_diocese 2023-02-19 Melanie Terry Saint Henry Catholic Church, Nashville [email protected] 6155798374 White Bluff TN Variation Name: ST. CROIX (June 17-23 or 24) - With Extra Freeday
type: With Extra Freeday2 Middle TN 2023-02-13 Stephen Fromhold Gwynedd Mercy Academy High School [email protected] 2156468815 Gwynedd Valley PA Variation Name: ST. CROIX (June 17-23 or 24) - With Extra Freeday
type: With Extra Freeday11 Gwynedd Mercy Academy High School 2023-02-08 Heather Schweizer CATHEDRAL OF ST CATHERINE [email protected] 610-442-0194 Allentown PA Variation Name: ST. CROIX (June 17-23 or 24) - With Extra Freeday
type: With Extra Freeday2 ALLENTOWN 2023-01-02 Kathy Nelson Our Lady of the Lakes (MN) [email protected] 6128653485 Brainerd MN Variation Name: ST. CROIX (June 17-23 or 24) - With Extra Freeday
type: With Extra Freeday3 Duluth, MN 2022-10-27 Lynn Pechiney All Saints [email protected] 7033932141 Manassas VA Variation Name: ST. CROIX (June 17-23 or 24) - With Extra Freeday
type: With Extra Freeday16 Arlington 2022-10-05 Joshua Mocek Notre Dame Academy [email protected] 4197251250 Toledo OH Variation Name: ST. CROIX (June 17-23 or 24) - With Extra Freeday
type: With Extra Freeday15 Toledo 2022-10-05 Ellice Bedel St. Susanna Catholic Church [email protected] 3174370543 Plainfield IN Variation Name: ST. CROIX (June 17-23 or 24) - With Extra Freeday
type: With Extra Freeday8 Archdiocese of Indianapolis 2022-10-05 Stephanie Hayes Our Lady of the Lake (TX) [email protected] 972-961-9383 Rockwall TX Variation Name: ST. CROIX (June 17-23 or 24) - W/O Extra Freeday
type: W/O Extra Freeday19 Dallas
| 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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| 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 | LUTHERAN SOCIAL SERVICES: File Upload | Entry ID | Sequence Number | Entry Date | Delete Entry Link | |
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