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
2022-12-07SammeyChisholmSaint Elizabeth of Hungary[email protected]2016773033WyckoffNJ13Newark
2022-10-07NancyVonthadenSS Peter and Paul[email protected]916-343-1168RocklinCA16sacramento
2022-10-06Msgr. MichaelBlissSt. Philomena Church[email protected]2177622566MonticelloIL16Peoria
2022-10-05DaleMasseySt. Louis (Ignite Youth Ministry)[email protected]9208662410LuxemburgWI20Green Bay
2022-10-05DEBTONERSAINT LUKE CHURCH[email protected]2039818817WESTPORTCT18BRIDGEPORT CT
2022-10-05KCKranichSt. Francis Borgia[email protected]2623771070CedarburgWI63Milwaukee
2022-10-05CarolHeithoffSt. Gabriel the Archangel[email protected]719-396-4215Colorado SpringsCO10Colorado Springs
2022-10-05AndreyaArevaloSt. Mary[email protected]7074464231VacavilleCA22Sacramento
2022-10-05NathanScheopnerSt. Dominic[email protected]6209374670Garden CityKS10Dodge City

Total quantity sold : 188

Email selected customers

Contact Leader's NameParish/Youth GroupCamp AttendingVehicle 1 - Type of VehicleVehicle 1 - Driver's NameVehicle 1 - Insurance CompanyVehicle 1 - Number of SeatbeltsAdd second vehicle?Vehicle 2 - Type of VehicleVehicle 2 - Driver's NameVehicle 2 - Number of SeatbeltsVehicle 2 - Insurance CompanyAdd third vehicle?Vehicle 3 - Type of VehicleVehicle 3 - Driver's NameVehicle 3 - Number of SeatbeltsVehicle 3 - Insurance CompanyAdd fourth vehicle?Vehicle 4 - Type of VehicleVehicle 4 - Driver's NameVehicle 4 - Number of SeatbeltsVehicle 4 - Insurance CompanyAdd fifth vehicle? Vehicle 5 - Type of VehicleVehicle 5 - Driver's NameVehicle 5 - Number of SeatbeltsVehicle 5 - Insurance CompanyAdd sixth vehicle?Vehicle 6 - Type of VehicleVehicle 6 - Driver's NameVehicle 6 - Number of SeatbeltsVehicle 6 - Insurance CompanyAdd seventh vehicle?Vehicle 7 - Type of VehicleVehicle 7 - Driver's NameVehicle 7 - Number of SeatbeltsVehicle 7 - Insurance CompanyAdd eighth vehicle?Vehicle 8 - Type of VehicleVehicle 8 - Driver's NameVehicle 8 - Number of SeatbeltsVehicle 8 - Insurance CompanyAdd ninth vehicle?Vehicle 9 - Type of VehicleVehicle 9 - Driver's NameVehicle 9 - Number of SeatbeltsVehicle 9 - Insurance CompanyDeparture Date & TimeDeparture City & CodeDeparture Airline & Flight #Do you have a connecting flight for this trip?Connecting City & CodeConnecting Airline & Flight #Connecting Date / TimeArrival Date & TimeDeparture 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?CommentsContact Leader EmailEntry IDSequence NumberEntry DateDelete Entry Link
Isabelle Calise
St. Mary's - Oviedo, Fl
Test
Mini van
John Brown
State Farm
6
No
No
164
1
I am completing this Verification Form for my _______________ Camp AttendingName of ParishName of GroupPlease list the names of all adults attending (18+)Verification Agreement: ParishVerification Agreement: CommunityContact Leaders NameContact Leader's SignatureContact Leader's EmailPastor's NamePastor's SignatureEntry IDSequence NumberEntry DateDelete Entry Link
Parish Youth Group
Test
St. Mary's - Oviedo, Fl
AGREE
Isabelle Calise
Bill Smith
163
1
Parish Youth Group
Test
St. Orlando
AGREE
Shaq Dunk
Fr. Penny Magic
162
2
NameEmailCamp (City) AttendingChurch/Parish CommentsPlease upload your letter of suitability belowEntry IDSequence NumberEntry DateDelete Entry Link
Bill Smith
Test
St. Mary's
160
1

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 PhoneEmailFirst Choice Service AssignmentSecond Choice Service AssignmentConstruction: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 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 SpecifyEntry IDSequence NumberEntry DateDelete Entry Link
John Brown
JB
St. Peter
No
1
Male
Large
Youth (under 18)
10th
Work project (painting, indoor clean up, maintenance, repair work, outdoor yard work)
Work at a social service center (homeless shelter, food distribution center)
2
1
1
2
1
1
04/30/2008
Susan Brown
Mother
(407) 123-4567
none
none
Dr. Miller
(407) 321-7654
09/09/2019
United Healthcare
8009012232
112256
AGREE
AGREE
AGREE
Susan Brown
AGREE
161
1
Crystal Ball
Christie
St. Peter
No
Female
Small
Adult (21 and older)
(444) 444-4444
Work with children at day care centers for low-income families
Work at a social service center (homeless shelter, food distribution center)
1
1
1
3
1
1
I love working with kids.
Sensitive to sun
12/07/2022
Jim Ball
Spouse
(888) 888-8888
Allergic to peanuts
None
Dr. Horace Cope
(987) 654-3210
12/01/2022
Aetna
987654321
123456
AGREE
AGREE
AGREE
AGREE
No
153
2
Zacchaeus SycamoreTree
Holy Cross
No
Male
3XL
Adult (21 and older)
(987) 654-3234
Work at a social service center (homeless shelter, food distribution center)
Work with children at day care centers for low-income families
1
2
2
3
3
3
12/11/1877
Kevin Mccallister
Brother
(456) 786-5467
Dr. Doctor
(786) 546-7865
12/19/2022
State Farm
Policy123
2468
AGREE
AGREE
AGREE
AGREE
No
152
3
Mickey Mouse
St. Peter
Yes
Male
Small
Youth (under 18)
9th
Work project (painting, indoor clean up, maintenance, repair work, outdoor yard work)
Work project (painting, indoor clean up, maintenance, repair work, outdoor yard work)
5
5
5
5
5
5
Magical
12/17/2022
Minnie Mouse
Girlfriend
(123) 456-7890
Dr. Donald Duck
(123) 456-7890
12/16/2022
Disney
12345
12345
AGREE
AGREE
AGREE
Walt Disney
AGREE
150
4