Youth Transport Form

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:

  • Mouse: Just click on any field and begin typing.
  • Keyboard: Use TAB to go through the form and use the SPACEBAR to select the radio buttons. (NOTE: only press ENTER when you are completely finished)
  • Click the SUBMIT button at the bottom when you are finished.

Please provide your information

Use this format: xxx-xxx-xxxx

Please provide the teen's information

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

Teen Help Provider (school or program)

Use this format: xxx-xxx-xxxx

Educational Consultant (if you are using one) toggle

History Information

Other Problems or Issues

Do any of the following apply to your teen?
If any can be answered "Yes" please provide a brief explanation.

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?
This must be clicked for us to receive the form.



Questions?

Customer Log in

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Troubled Youth/Teen Help Provider Directory