Our Board has approved a Winter Respite/Recreation Program.

(Please scroll down to apply)

Application Deadline is December 3, 2018

Thank you to CIBC Miracle Day and VanKam Freightways
For their donations to the under 13 yrs old respite program

Thank you to Coast Capital Savings for a Grant towards our Teen program and the Teen Respite and Recreation programs.

Applicant/Guardian(s)*:

Telephone*:

Address*:

City*:

Province*:

Postal Code*:

Your Email*: (required)

Currently a member of VSCA*: (You can sign up first by clicking here)
YesNoI don't Know

As you may know, we are a volunteer society. Please list here ways you have helped or willing to help the society (VSCA):

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 any additional information you want us to know (incl additional ASD Child or amount requested if less than maximum:

You may attach proof of autism diagnosis here or email to respite@victoriaautism.com by deadline
(file limit 4mb, you may need to lower camera/phone resolution):
No need to include if it has been previously provided.

Second Attachment (optional):

Recreation or Respite Provider's Name to put on cheque:*

Recreation or Respite Provider's Phone Number:*

Recreation or Respite Provider's Email:

Any other information you would like us to know?:*