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. 

2018 Applications- you may download the applications below, print, and mail it to:

308 Fairmount Terrace, Mountville PA 17554 


*The application MUST be mailed in to the address above OR scanned and emailed to in order to assure a spot for your child for our 2018 season. (Physcial forms can be sent in at a later date) no exceptions. 







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?