Section 1
To be completed prior to the administration of Corporal Punishment
 

1.1    Pupil's Name                         ______________________________________

1.2    Description of Offence           ______________________________________
                                                      ______________________________________
                                                      ______________________________________

1.3    Date of Offence                     __________________________

1.4    Punishment Awarded
         a    Strokes                            _____________
         b    Instrument                        __________________________

1.5    Date of Punishment                __________________________

1.6    Master Administering Punishment
         I confirm that this pupil is to receive corporal punishment as described above,
         in accordance with school rules.
         a.    Name                             ______________________________________
         b.    Position                          ______________________________________

1.7    Signature of Pupil
         I understand that I am to receive corporal punishment as described above,
         in accordance with school rules.
         a.    Signed                            ______________________________________
         b.    Date                               __________________________
 
 

Section 2
To be completed following the administration of Corporal Punishment
 

2.1    Total Strokes Administered  _____________

2.2    Reason for Additional           ______________________________________
         Strokes (if any)                     ______________________________________

2.3    Further Action (if any)           ______________________________________
                                                      ______________________________________
                                                      ______________________________________

2.4    Signature of Master
         I confirm that I have administered corporal punishment to this pupil, as
         described above, in accordance with school rules.
         a.    Signed                            ______________________________________
         b.    Date                               __________________________

2.5    Signature of Pupil
         I confirm that I have received corporal punishment as described above, in
         accordance with school rules.
         a.    Signed                            ______________________________________
         b.    Date                               __________________________
 
 

Distribution

Copies to be circulated as follows:
Copy 1     Headmaster's Secretary
Copy 2     Pupil
Copy 3     Parents - at discretion of Master administering punishment