Time-Out Parent / Guardian Name First Name Last Name I do hereby state that I have read andreceived acopy of the facility's Discipline and Behavior Management Policy and that the facility's director/operator (or other designated staffmember) has discussed the facility's Disciplineand Behavior Management Policy with me. Time Out Policy 'Time-out" is the removal of a child for a short period of time (3 to 5 minutes) from a situation in which the child is misbehaving and has not responded to other discipline techniques. The "time-out" space, usually a chair, is located away from classroom activity but within the teacher's sight. During "time-out," the child has a chance to think about the misbehavior which led to his/her removal from the group. After a brief interval of no more than 5 minutes, the teacher discusses the incident and appropriate behavior with the child. When the child returns to the group, the incident is over and the child is treated with the same affection and respect shown the other children. Child's Name Date of Child's Enrollment MM DD YYYY Type Parent/Guardian Name & Date Director/Operator Name & Date Thank you!
