Referral Form

Below you may access our referral form in order to request a placement for a child at Young Star House. We will not consider the placement of a child unless the referral form is filled out as completely as possible. The child should be in the care of a child protection agency with jurisdiction in Ontario. If you are unsure of the status of the child or if they meet the necessary requirements please do not hesitate to contact us.

Note: Submission of a referral does not guarantee placement. Placement of a child is subject to bed availability and a team evaluation as to whether the child will potentially benefit from our program. We also consider the potential impact on the other residents currently within the home. Please contact us if you have any questions.

The following file is stored in the Adobe PDF file format for your convenience. This form can be printed, filled out and faxed to (807) 482-2240 or emailed to This email address is being protected from spambots. You need JavaScript enabled to view it. for processing:

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Friday, September 25, 2020

Bed Availability

Young Star House is


Program is Currently Full

for our 
Current Program Year 


 Note: New referrals will be placed on our waitlist.
Please email us regarding the wait list status.

Submit our referral form to be placed on our consideration/waiting list.