2026 Diocesan Women and Teen Girls Retreat

2026 Diocesan Women and Teen Girls Retreat

Camp Shiloh, 753 Burnt Meadow Road, Hewitt, NJ
Attendee Information

Please fill out a separate form for each participant. There is NO fee to attend!
Participant information:*

Youth Participant (Ages 14-17)Adult Participant (18+)
Who will be transporting your minor? (ie: John Smith, father)*
Participant's Full Name*

First NameLast Name
Home Address*

Street Address

Street Address Line 2

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Email Address*
Cell Phone Number
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Date of Birth*

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Date
Age*
Grade in School*
Parent Name*

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Parent Email*
example@example.com
Parent Cell Phone Number*
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Which diocese are you from? If outside of the OCA, please review the "Other" options and choose your jurisdiction.*
Parish (name, city, and state)*
If you do not attend a parish in the OCA Diocese of New York & New Jersey, please share your Parish information in the following format: Saint John the Baptist, Little Falls, NJ*
example: Saint John the Baptist, Little Falls, NJ
OCA Diocese of New York & New Jersey Media Release Form

Sign ONLY IF if you agree with the below.
I hereby authorize and consent to the use of my/my child’s visual image by the Orthodox Church in America (OCA), the Diocese of New York & New Jersey, and the OCA’s Diocese of New York & New Jersey Department of Youth Ministry for appropriate purposes, including but not limited to: still photography, video, electronic and print publications, the OCA’s Diocese of New York & New Jersey Department of Youth Ministry social media pages on Facebook, Instagram, YouTube, and websites.

In witness whereof, I give this consent with no claim for payment by digitally signing my name below:
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2026 Diocesan Women and Teen Girls Retreat

Attendee Information

OCA Diocese of New York & New Jersey Media Release Form