Troubled Teen Boot Camps

1. Does your troubled teen fail to complete tasks that require effort regardless of the future importance of the task? (e.g. school work)

2. Does your troubled teen attempt to negotiate and/or manipulate in order to avoid consequences and problems?

3. Does your troubled teen justify negative behaviors by blaming others?

4. Is your troubled teen unwilling to recognize the impact of his/her behavior on family and friends?

5. Does your troubled teen use manipulation and deception in order to change others' points of view?

6. Does your troubled teen have weekly outbursts or mood swings?

7. Does your troubled teen avoid participating in family activities and social events?

8. Does your troubled teen become impatient or easily agitated with others?

9. Does your teen have an intense fear of gaining weight or becoming fat?

10. Has there been a recent drop in your teen's performance at school?

11. Is it difficult for your teen to relate with others or make friends?

12. Does your teen frequently fail to finish schoolwork, projects or chores?

13. Does your teen fail to follow through with responsibilities or instructions?

14. Is your teen forgetful or often viewed as lazy?

15. Does your teen argue with adults and authority figures?

16. Is your teen failing one or more courses in school?

17. Has your teen undergone therapy and/or counseling without results?

18. Does your teen do dangerous things without considering the consequences, "a daredevil?"

19. Has your teen been physically abusive to animals?

20. Is your teen extremely self-conscious?

21. Does your teen appear depressed, sad, tearful or irritable nearly every day?

22. Has your teen run away from home? (More than twice)

23. Is your teen sexually active?

24. Does your teen engage in self-injurious behaviors and/or threaten to inflict self-harm?

25. Does your teen use illegal drugs and/or alcohol?

Note: Please provide the information requested below in order for a counselor to get in touch with you within 24 hours to discuss the result and courses of action you can consider.

Parent First Name:

Parent Last Name:

Address:

City:

State:

Zip Code:

Country:

Telephone No:

Email:

Child First Name:

Child Last Name:

Child's Gender:

Child's Age:

Are you looking at enrolling your child:

Method of Contact:

How did you hear about us?

Referred by:

Comments:

Please enter the code on the box below the image:

Your teen's risk score is:

Thank you for using our questionnaire.

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TeenBootCamps.org Team