Victory Junction Family Weekend Application

Trillium Health Resources invites members who experience IDD and their families to a family camp weekend at Victory Junction in Randleman, NC. Please note, this is the first part of the application process. Trillium staff and/or Victory Junction staff will contact you for additional information. This is open to only members from the Trillium catchment area and who are under the age of 18.

Please provide the first and last name of the member who receives services/support through Trillium Health Resources.

Please select the session that you would prefer to attend.

Please list any medical conditions or intellectual and/or developmental disability(ies).

Please list any supportive devices that will be utilized during the family weekend (i.e communication device, mobility aids, other medical equipment).

Please list any known allergies and reaction.

Powered by Smartsheet Forms
Privacy Policy   |   Report Abuse
Your submission is being processed. Please do not close this browser window until complete.