4321.12 F1 Use of Physical Restraints/Time Out Regulation

Parental Notification Form

[PLACE ON PRINCIPAL’S LETTERHEAD]

[DATE]

[PARENT’S NAME]

[PARENT’S ADDRESS]

Dear ,

This letter serves as a follow-up to my phone call on [ENTER DATE] to inform you that your child was [restrained/placed in a time out.] due to behavior that created an emergency situation. Attached you will find a copy of the written report related to the incident, with an explanation of your child’s behavior and the interventions that were put into place to better help your child be more successful in school. If you would like to meet regarding this incident, you may contact me at the phone number or email address below. 

Contact Name Title

Contact Phone Number Email Address

Sincerely,

School Principal

Approved by the Board of Education: 10/19/23

Reviewed and re-approved by Board of Education: 4/23/25

Click here to view the PDF.