(School District)
(Your address)
(Your telephone number)
(Address)
(Date)

Re: (child's name and birthdate)

Dear (Principal, Program Director, or IEP Team Leader):

My child, (child's name), is a ________ grade student at ______ school. (Child's
name) has a disability (or insert label) and is receiving special education
services. I want to thank you for all of the help and positive support you and
the teachers and staff at name of school have provided child's name over the
years.

We are concerned that child's name's behavior challenges are being, or might in
the future be, addressed in part through the use of aversive interventions,
restraint or seclusion (including seclusionary time-out or procedures referred
to as "physical management" or "restrictive procedures"). Examples of these
practices include, but are not limited to: forcible holding or dragging, the use
of ties or straps, sprays in the face, slaps, deliberate humiliation,
deprivation of nutrition or exercise, and time out rooms. This letter is to make
clear that I have not authorized and will not consent to any activity that
involves the use of any of these procedures at school or while child's name's is
transported to or from school. I know that special education law requires the
use of a Functional Behavioral Assessment (FBA) which is expected to lead to a
Positive Behavior Support (PBS) plan to address behavior challenges. If the
school feels child's name's behavior is so challenging that aversive or
restrictive procedures, seclusion, time out, physical management, or restraint
are being considered or used, it is clear to me that there is need for a FBA and
the development of an effective PBS plan. I expect to participate in this
assessment and the development of a PBS plan for my child.

I am sure you are aware of the number of news reports in recent years describing
the deaths, trauma, and injury of children with disabilities while or just after
being subjected to aversive interventions, restraint, or seclusion. I am writing
this letter as a precautionary action and to provide clear instructions that
none of these techniques are to be used with my child. If any of these
techniques are currently being used, or have in the past been used, it is
important that you notify me of this and terminate any use of such procedures
immediately.

If (child's name)'s behavioral issues are a challenge now or at any time in the
future, I am requesting that a behavior support team meeting be convened to
discuss these challenges, plan for an FBA across environments, and begin work
toward establishing a positive behavior program to address child's name's
particular needs. I wish to exercise my right to participate in all such
meetings.

I want to work with you and with (child's name)'s teachers and professionals at
name of school to be sure that child's name learns to develop positive
behavioral skills in an environment that is safe for him/her, for his/her peers,
and for school personnel. I, like you, want my child's school to be a safe and
secure environment where all students can learn. I want to work with you to help
create that environment.

Sincerely,

(Your name)

I've been so lucky with schools so far, but there are so many people who have huge troubles. Thank you for finding and posting this.