Applicant/Guardian(s)*:

Organization Name:

Telephone*:

Address*:

City*:

Province*:

Postal Code*:

Country:

Your Email*: (required)

First Child with autism diagnosis:

Child's Birth Date (YYYY-MM-DD):

Second Child with autism diagnosis:

Child's Birth Date (YYYY-MM-DD):

Third Child with autism diagnosis:

Child's Birth Date (YYYY-MM-DD):

You may enter other sibling's names and ages if you wish:

Please indicate if this is a Family, Professional or Supporter Membership*:

Attach proof of autism diagnosis here:(Not required if previously provided)
(Examples.. a physician signed document stating diagnosis and birthday, copy of original assessment or an email copy of summary of funding indicating age obtained by calling Autism Funding Unit(AFU).

For our 50th year, the board has decided to waive membership fee for our organization in an effort to allow us to serve more families with Autistic Children. However, please consider a donation to help support our charity.

A charitable tax receipt is provided by CanadaHelps

Donate Now Through CanadaHelps.org!

Donation can also be made by cheque and mailed to 

Victoria Society for Children with Autism
#306-620 View Street
Victoria, BC V8W 1J6

Thank you for your support!

Membership is still important and applications/renewals are due at the start of the Calendar Year in January.

Please fill out the required information.

You may register as a Family, Professional or Supporter.

 Professionals and Supporters benefit by:

* Keeping up with the latest Victoria area autism programs, activities and workshops through our newsletters.

* Gaining access to our lending library of books, videos and software on all aspects of autism.

 Families can enjoy all of the above plus:

* Monthly meetings where you can meet other parents of children with autism.

* Access to respite funding or recreation program funding, as available.  Must provide proof of diagnosis and birthdate for each eligible child that is in your care.

* Access to free monthly social events for you and your children.

* Access to our equipment lending library.