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.
Member Date of Birth
Contact email address
Contact phone number
Number of people in Family Unit
County of Residence
Please select the session that you would prefer to attend.
Member's support needs
Please list any medical conditions or intellectual and/or developmental disability(ies).
Member's supportive devices
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.
Send me a copy of my responses
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