Name of Referring Party: Agency: Contact Number: Email: Name of Youth : Date of Birth: Case Number: Risk Factors (check all that apply): Known family/friends in History of exploitation (i.e. by stripping company , other) Runaway Frequency: H ow often has the minor runaway? Duration: H ow long is the minor usually AWOL? Location: W here does the minor usually run away to? Significantly older boyfriend Frequent travel to other cities Which cities: Gang affiliations: History of sexual and/or physical abuse Large tattoos (or other forms of branding) Frequent stays in motels and/or homelessness Reason For Referral (Detail/Other): Dependency cases please email completed form to cwscsec@fresnocounty.gov Delinquency cases please e mail completed form to fridaycourt@fresno.courts.ca.gov SUPERIOR COURT OF CALIFORNIA COUNTY OF FRESNO Friday Court Referral Form PJV-29 E0-19MANDATORY Friday Court Referral Form American LegalNet, Inc. www.FormsWorkFlow.com