2026 Pocono Mountains Shibir Registration
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
example@example.com
How many Adults?
Adult Name 1
First Name
Last Name
Adult Name 2
First Name
Last Name
Adult Name 3
First Name
Last Name
Adult Name 4
First Name
Last Name
Adult Name 5
First Name
Last Name
How many Children?
Child Name 1
First Name
Last Name
Child Age 1
Child Name 2
First Name
Last Name
Child Age 2
Child Name 3
First Name
Last Name
Child Age 3
Child Name 4
First Name
Last Name
Child Age 4
Child Name 5
First Name
Last Name
Child Age 5
Special Message
Your family’s stay includes 4 nights (July 24–28) of lodging, and meals. "I Am Sundersath" humbly requests a minimum donation of $551 per family (2 Adults and 3 Children) to attend. If you feel inspired to give more, your generosity is deeply appreciated and helps support the mission and other families. Please use the QR Code bottom for payment.
Submit
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