This is a form that I originally created while in the credential program and never thought to make it cute and/or for TpT until today! This form works well for kids of all grade levels and ages to get them thinking about their behavior and class and take responsibility for it. Sit down with your misbehaving student and walk through the questions together. Changing their behavior is a TEAM effort - it takes effort from them, you and their parents.
When the form is complete have parents sign it (my recommendation is to catch parents at drop-off or pick-up in elementary school) and then make a copy to give back to them.