Youth Transport Form - USA Guides Inc. - Safe. Reliable. Insured.

A well prepared and informed transport team is a safe team. To assure that our transport Guides are well informed and prepared for each transport it is important that we have extensive and thorough background information on the Teen we are to transport. This information is important as we will be spending, in a majority of cases, many hours together and will be engaged in conversations, and gives our Guides needed information on what topics of conversation to either avoid or engage in with the teen during a transport.

This information will also assist the guides in understanding and evaluating what may trigger inappropriate behavior in the teen. The information will also be used to effectively observe for medical or emotional problems.

Please fill out the form below

Form Navigation:

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Click the SUBMIT button at the bottom when you are finished.

Please provide your information

First Name

Last Name

Address

City

State

Zip

Cell PhoneUse this format: xxx-xxx-xxxx

Work Phone

Home Phone

Which phone number should we contact you with?

Cell Phone

Work Phone

Home Phone

I / we have full legal custody and or rights to place this minor child in a school or program, and to contract for the services of USA Guides, Inc.

Yes

Special notes or conditions concerning custody

Directions to your residence from the nearest major airport

Please provide the teen's information

Full Name

Gender

Male

Female

Height (Feet)

Height (Inches)

Weight (pounds)

Hair Color

Eye Color

Age

Date of Birth (MM-DD-YYYY)

Address of teen pick upAddress of exactly where the teen will be at the start of the transport.

Any disablities or medical problems, describe in
detail and include any required medication information

Teen Help Provider (school or program)

Program Name

Address

Contact Person

PhoneUse this format: xxx-xxx-xxxx

Educational Consultant (if you are using one) toggle

History Information

Do you know if your teen has been involved with drugs? If yes, do you know what type and frequency of use?

Do you know if your teen has been involved with Alcohol? If yes, do you know what type and frequency of use?

Do you feel that your teen is a flight risk? If yes, please explain.

Has your teen exhibited violence and or aggressive behavior? If yes, please explain in detail.

Original Program (If you are tranferring programs) toggle

Additional Information

Please provide any other information about your teen, their circumstance, or any information that you feel is important for us to know about so that we can conduct an informed and safe transport:

Also, please answer the following questions:

What date you would like this transport to take place?
Would you like to be contacted immediately after you submit?
What are you child's interests?
What are you child's food preferences?
Has this child been transported before?
Is your child athletic?

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Troubled Youth/Teen Help Provider Directory