Refer a Child Referral Form Do you know a child, ages 3-21 who has a life-threatening condition in Spokane, the Tri-Cities or a local outlying area? Refer them to Wishing Star! Child's Name*Age*Child must be between 3 and 21 years old.Child's Illness (If Known)GenderMaleFemaleFamily's Primary LanguageParent/Guardian Name*Family's Phone Number*Family's AddressCity*State*WashingtonIdahoFamily's permanent residence must be in Spokane, the Tri-Cities, or a local outlying area.Zip CodeYour Name*Your Phone Number*Your Email*Would you like to keep this referral anonymous?* Yes No Have you contacted the family about the referral to Wishing Star? Yes No Has the child received a wish from another wish granting organization?* Yes No I'm not sure. Comments: Please tell us more about this family's situation or any other information you think we should know.NameThis field is for validation purposes and should be left unchanged.