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Sign in Sheet School Violence: School violence is any mean word, look, sign, or act that hurts a person’s body, feelings, or things. Any mean or hurtful word includes any threats, put-downs, racial slurs name calling, sarcasm, joking, teasing, taunting, or ridiculing. Any mean or hurtful look includes any demeaning facial expression, eye rolling, starting, sticking out the tongue, and any sexual looks. Any mean or hurtful signs includes nasty gestures, threatening with a fist or a weapon, touching oneself or someone else in a sexual manner to cause embarrassment, and exposing one’s private parts. Any mean or hurtful overt acts includes slapping, pinching, hitting, punching, shoving, pulling, poking, kicking, tripping, stomping, petting, hair pulling, or beating. Any mean or hurtful covert acts includes ignoring or violating a person’s wishes or rights, silent threats, ostracizing, isolating others, standing in front of someone else who is standing in line, and manipulating friendships. Bullying: Bullying occurs when anyone intentionally, repeatedly, commits one or more of these violent acts again and again against a specific individual, and over time, inflicts, or even threatens to inflict, physical or emotional injury or discomfort upon another person’s body, feelings, or possessions.
Name/Date: Name/Date: ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________
Life Skills Worksheet (Student Consequence- Violence Level 2 or Higher) Choices:
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_____________________________________________________________________________ Consequences:
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_____________________________________________________________________________ Contract:
_____________________________________________________________________________ _________________________________________________________________ _________________________________________________________________ - Source: Johnson Institute; Respect & Protect: Violence Prevention and Intervention (Participant Manual); Hazelden: Minnesota; 1999.
Respect & Protect (Violence Level 2) I agree to the following terms:
Privileges: Consequences:
The following may also take place:
_________________________________________________________________ _________________________________________________________________ - Source: Johnson Institute; Respect & Protect: Violence Prevention and Intervention (Participant Manual); Hazelden: Minnesota; 1999.
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