Action Taken (Check all that apply):

* Verbal Warning

* Verbal Apology - Voluntary

* Verbal Apology – Request by teacher

* Written Apology

* Think About It – Reflection Sheet

* Call to Parent

* Recess Time-Out

* Referral to Principal

* Parent/Teacher Conference

* Parent/Teacher/Principal Conference

* After School Detention

* Other _________________________________________

Notes (about action taken):

___________________________________________________________________________________________________________________________________________________

“Love your neighbor as yourself.” Matthew 22:39