Parent Referral Form
Earn a FREE week of tuition ( if you are existing Lighthouse Family ) OR $ 250 in cash for Non-Lighthouse Family members **
Fill out this form to refer a Friend or Family member who might need care
Referrer Information
First Name
Last Name
Phone
Email
Are you currently a Children's Lighthouse family?
No
Yes
Referred Family
First Name
Last Name
Phone
Message
** Contact us for more details.
Submit
By submitting this form I agree to receive information and tour reminder alerts via email and text message.
