UFS Profile | National Youth Transport Services | Teen Transport Services | Troubled Teen

Father Full Name:

Mother Full Name:

Address Street, City, State, Zip)

Email:

Home Phone:

Work Phone:

Mobile Phone:

Fax Number:

Which number should we contact you with?

Home
Work
Mobile

On the Primary number you would like us to call back on, does it allow blocked calls?

Yes
No

Place of Employment:

Do you have full legal custody?

Yes
No

Special notes or conditions concerning custody:

Nearest major airport:

Student's Full Name:

Student's Gender:

Male
Female

Student's Height:

Student's Weight:

Student's Hair Color:

Student's Eye Color:

Student's Age:

Student's Date of Birth:

Address of Student (This address should be the address were our agents will be picking up the student):

Students Cell:

List any distinguishing characteristics:

How many brothers & sisters does the student have (include step brothers and sisters)

Briefly explain relationships with siblings:

Hobbies or Other Interests:

Favorite Foods, include restaurants, snacks, and sodas (UFS will stock the vehicle with some food).

Is the Child Running Away & Not Coming Home Often? If Yes, Please Explain.

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

Program Name:

Program Address:

Program Contact Person

Program Phone:

Program Email:

Coordinating Company:

Coordinator's Name:

Coordinator's Email:

Coordinator's Phone:

Do you know if your teen has been involved with alcohol and/or drugs? If yes, please explain frequency and type.

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

Do you feel that your teen is a run risk? If yes, please explain:

Do any of the following apply to your student? If yes, please explain.

School Problems:

Adopted:

Divorce Issues:

Fitting in Problems:

Emotional Problems:

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:

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