DETENTIONS

 SAMPLE DETENTION NOTICE FORM- DETENTIONS WILL BE HELD AFTER SCHOOL FROM 3:40-4:40

PARENTS MUST PROVIDE TRANSPORTATION FOR PICK UP

PLEASE READ CAREFULLY AND AVOID BEHAVIORS THAT LEAD TO DETENTIONS.

GENERAL INFORMATION

Last Name:

First:

Grade:

Date of Incident:

Time of Incident:

Prepared  by:

Title of

 Reporter:

Location of

 Infraction:

reason for DETENTION (Check all that apply)

 

Unacceptable Language

 

Willful Refusal to Follow Directions or Instructions

 

Disruptive Horseplay

 

Disruption in:  Cafeteria / Classroom / Hallway / Restroom / Outside

 

Chronic Tardiness

 

Multiple Dress Code Violations

 

Willful Disrespect to School Official

 

Skipping Class or Unauthorized Area

 

Willful Damage to School Property

 

Willful Damage to Personal Property

 

Other Infraction: (Explain) _________________________________

 

 

Description of Infraction:

prior action(s) taken by teacher

 

Conference  with Parents: Date(s)

 

Parent Notification by Letter--Date(s):

 

Previous Parental Notification(s) by Phone

Date/Time

 

 

Date/Time

Date/Time

 

Parental Notification on this Incident

 

Verbal Warning--Date(s)

 

Conference with Student--Date(s):

 

 Lunch Detention--Date(s)

 

In-Team / In-Grade Displacement--Date(s):

 

Other Action(s):

 

After-School Detention--Date(s):

Detention Information

No. of Days:      

Inclusive Dates:

Room #:  709

Start Time:   3:40 PM

 

End Time:    4:40 PM

 

Student Signature: ______________________________________________    Date:_________________________________

 

TEACHER SIGNATURE: ______________________________________________     DATE: ________________________________

 

PARENT SIGNATURE: ________________________________________________  DATE:_________________________________

 

                 
 

 

**Please note: students will not be allowed to serve the detention without a detention form that has been signed by a parent or guardian. 

 

**Transportation is the responsibility of the student and the parents.  Students are expected to be picked up directly following the detention.  Failure to attend the detention on the assigned date will result in an additional detention or an administrative referral.  Misbehavior during the detention will not be tolerated and will also result in an administrative referral.