Thanks to the following donors Marymax Fund, Anonymous Fund, Ernest and Frances Hudson Family Fund and the Hugh Turner Memorial Fund who donated through the Victoria Foundation to make our respite and recreation program viable this winter.

The Board and volunteers like yourself are working hard to increase the funds we will be able to provide. We NEED YOUR HELP at the resolution run (Click Here to register) or helping wrap presents at our Christmas wrapping table. (Click Here to register)

Respite Application Deadline is December 8th at noon.

Applicant/Guardian(s)*:

Telephone*:

Mailing Address (Include unit/appt number)*:

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 ways you can 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 (ie for instance, additional ASD Child):

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. Don't worry, if we can't find it, we will simply ask you by email.

Second Attachment (receipt) (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?:*