Incident Report

At CH we seek to provide a safe and positive learning environment in which each student is respected and nurtured. Please call the school or use this form to report any incident that may interfere with a respectful learning atmosphere.

All reports will be handled with the utmost privacy and care.

Name of Student*
Grade Level*
Teacher*
Parent's Name*
Name of other Child or Children*
Location of Incident*
Phone Number*
Email Address*
Date of Incident*
MM slash DD slash YYYY
Time of Incident*

: Hours

Minutes

AM/PM
Brief Description of Incident*
Submitting this form begins a process in which the parent(s) will be contacted by an administrator on the next school day.*
- I undersand the above statement
CAPTCHA
Name
This field is for validation purposes and should be left unchanged.