Camper Application

If your child will be new to the Helen Diller Vacation Home, please fill out the preliminary application below and submit it to the camp Director for review. 

2017 Applications- you may download the applications below, print, and mail it to:

 151 Cartledge Lane, Millersville, PA 17551 

 

2017_camper_application

 

2017_sighted_sibling_application

 

2017_alumni_application 

Parent Information

Camper Information

Does your child require 1-1 assistance with daily living skills? (dressing, eating, bathing, toileting)
Does your child exhibit behaviors which require 1-1 assistance or which you feel would hinder the movement of his/her group?
Does your child require medical assistance beyond taking medication on a daily basis?
Are there activities in which your child cannot participate?

Optional