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 three files are the same form stored in PDF, DOC and DOCX formats 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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Monday, June 17, 2019

Bed Availability

Young Star House currently has


0 Bedspaces Available

in the Current 2018-2019 Program.


5 Bedspaces Available

for August 19, 2019-2020 Program Entry.


 Please give us a call regarding applications for bed space.

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