Group List
Total quantity sold : 188 Date Billing First name Billing Last name Billing Company Billing E-mail Billing Phone Billing City Billing State Variation Order Qty Total _billing_diocese 2022-12-07 Sammey Chisholm Saint Elizabeth of Hungary [email protected] 2016773033 Wyckoff NJ 13 Newark 2022-10-07 Nancy Vonthaden SS Peter and Paul [email protected] 916-343-1168 Rocklin CA 16 sacramento 2022-10-06 Msgr. Michael Bliss St. Philomena Church [email protected] 2177622566 Monticello IL 16 Peoria 2022-10-05 Dale Massey St. Louis (Ignite Youth Ministry) [email protected] 9208662410 Luxemburg WI 20 Green Bay 2022-10-05 DEB TONER SAINT LUKE CHURCH [email protected] 2039818817 WESTPORT CT 18 BRIDGEPORT CT 2022-10-05 KC Kranich St. Francis Borgia [email protected] 2623771070 Cedarburg WI 63 Milwaukee 2022-10-05 Carol Heithoff St. Gabriel the Archangel [email protected] 719-396-4215 Colorado Springs CO 10 Colorado Springs 2022-10-05 Andreya Arevalo St. Mary [email protected] 7074464231 Vacaville CA 22 Sacramento 2022-10-05 Nathan Scheopner St. Dominic [email protected] 6209374670 Garden City KS 10 Dodge City Email selected customers
| 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Isabelle Calise | St. Mary's - Oviedo, Fl | Test | Mini van | John Brown | State Farm | 6 | No | No | 164 | 1 | January 6, 2023 3:17 PM |
| 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+) | Verification Agreement: Parish | Verification Agreement: Community | Contact Leaders Name | Contact Leader's Signature | Contact Leader's Email | Pastor's Name | Pastor's Signature | Entry ID | Sequence Number | Entry Date | Delete Entry Link |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Parish Youth Group | Test | St. Mary's - Oviedo, Fl | AGREE | Isabelle Calise | Bill Smith |  | 163 | 1 | January 6, 2023 3:06 PM | ||||||
Parish Youth Group | Test | St. Orlando | AGREE | Shaq Dunk | Fr. Penny Magic |  | 162 | 2 | January 6, 2023 3:04 PM |
| Name | Camp (City) Attending | Church/Parish | Comments | Please upload your letter of suitability below | Entry ID | Sequence Number | Entry Date | Delete Entry Link | |
|---|---|---|---|---|---|---|---|---|---|
Bill Smith | Test | St. Mary's | 160 | 1 | January 6, 2023 2:51 PM |
| 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 ID | Sequence Number | Entry Date | Delete 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 | January 6, 2023 2:58 PM | ||||||||||
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 | December 21, 2022 12:41 PM | |||||||||
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 | December 21, 2022 12:40 PM | ||||||||||||||
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 | December 17, 2022 11:13 AM |