Weekly Behavior Log- Parent Communication Form

Student Name:______________________________________ Class:_____________________________ Period:________ Teacher:___________________________

Parents: Please initial daily and return to the teacher. Feel free to contact me with any questions and/or to set up a meeting. My information is listed below.
Thank you.
Date Behavior Intervention/Consequence Comments Parent Initial/ questions

MON Attitude Acting out Bathroom Verbal or written warning 1st, 2nd, 3rd
Bullying Cell phone Off task Reflection form . Private conversation
hands/objects to self Disrespectful Seat change Detention . Out of class .
Parent contact Request parent meeting
Disruptive Didn’t follow directions Talking Request for parent to shadow student Initials _____________
Out of seat Profanity Other: Other:

TUES Attitude Acting out Bathroom Verbal or written warning 1st, 2nd, 3rd
Bullying Cell phone Off task Reflection form . Private conversation
Seat change Detention . Out of class .
hands/objects to self Disrespectful
Parent contact Request parent meeting
Disruptive Didn’t follow directions Talking Request for parent to shadow student Initials _____________
Out of seat Profanity Other: Other:

WEDS Attitude Acting out Bathroom Verbal or written warning 1st, 2nd, 3rd
Bullying Cell phone Off task Reflection form . Private conversation
hands/objects to self Disrespectful Seat change Detention . Out of class .
Parent contact Request parent meeting
Disruptive Didn’t follow directions Talking Request for parent to shadow student Initials _____________
Out of seat Profanity Other: Other:

THURS Attitude Acting out Bathroom Verbal or written warning 1st, 2nd, 3rd
Bullying Cell phone Off task Reflection form . Private conversation
hands/objects to self Disrespectful Seat change Detention . Out of class .
Parent contact Request parent meeting
Disruptive Didn’t follow directions Talking Request for parent to shadow student Initials _____________
Out of seat Profanity Other: Other:

FRI Attitude Acting out Bathroom Verbal or written warning 1st, 2nd, 3rd
Bullying Cell phone Off task Verbal or written warning 1st, 2nd, 3rd
hands/objects to self Disrespectful Reflection form . Private conversation
Seat change Detention . Out of class .
Disruptive Didn’t follow directions Talking Parent contact Request parent meeting
Out of seat Profanity Other: Request for parent to shadow student Initials _____________
Other:

Student Signature: _____________________________________ Date: ____________ Teacher Contact Information

Parent Signature: _____________________________________ Date:_____________ Email:
School Phone: