Fill and Sign the Form School Permission

PERMISSION TO DISCIPLINE I,       as parent/guardian of       , and who attends       hereby grant permission to discipline in accordance with school policy and only after first contacting me of any punishment in excess of a level one (I) violation. Disciplinary actions are only to be taken by the following school employed individuals:       Level I Infractions Failing to remain seated on bus ____________________________________________ Shoving, cussing, horseplay on bus_________________________________________ Field Trip misbehavior, hygiene issues, dress code violations, hall roaming, littering, excessive talking, eating/drinking in classrooms, misbehavior in assemblies ________________________________________________________________________ Cussing, unprepared for class______________________________________________ Other behaviors________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Examples of Level I consequences: detention, recess suspension, verbal warning, phone call home, confiscation, ____________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Level II Infractions These are offenses that consistently disrupt the learning environment. Persistent Level I behavior________________________________________________ Lying, cheating, disrespect, defiance of authority______________________________ Use or possession of tobacco______________________________________________ Hitting, biting, spitting __________________________________________________ Cutting class___________________________________________________________ Leaving school grounds without permission__________________________________ Unlawful harassment____________________________________________________ Examples of consequences for Level II infractions are a letter sent home, referral to principal, detention, denial of privileges, written record of offense, in school suspension,______________________________________________________________ _______________________________________________________________________ - 1 – Copyright 2004 USLegalforms.com Level III Infractions These are acts whose frequencies disrupt the academic climate and are directed against individual persons or properties. Persistent Level II behavior_______________________________________________ Insubordination and/or defiance of authority__________________________________ Theft_________________________________________________________________ Threats, extortion, bribery, fighting, vandalism, smoke bombs, alcohol/drugs, sexual harassment, possession of gambling paraphernalia, unapproved possession of cell phone___________________________________________________________________ ________________________________________________________________________ Examples of Level III consequences include multiple days of suspension, parent conference, referral to police ________________________________________________ ________________________________________________________________________ Level IV Infractions These misbehaviors disrupt the learning environment and threaten the health, safety, and welfare of others. These infractions may require the use of law enforcement interaction and/or removal from school. Persistent Level III misbehavior___________________________________________ Terrorist threats or acts__________________________________________________ Weapons or look- alikes__________________________________________________ Harassment____________________________________________________________ Arson________________________________________________________________ Assault, battery, false imprisonment, conversion ______________________________ ________________________________________________________________________ Examples of Level IV consequences are removal from school, referral to police, expulsion________________________________________________________________ ________________________________________________________________________ I further agree to hold the school, it officials, officers, directors, teachers, and members free of any liability for administering any form of punishment after having notified me of any violation committed by the aforementioned child. _______________________       Signature Date - 2 – Copyright 2004 USLegalforms.com