I created this form to help resolve behavior issues in my classroom. I use a clip chart in my room, and students that move their clip to "parent contact" because of behavior issues need to stay in for recess and fill out this action plan. On the action plan, they need to identify what the problem is, what caused the problem, and what they will do solve the problem. It includes a line for a student signature and a parent signature. The next day, I collect the signed form and have a short talk with the student to remind them of the action they will take so that the behavior does not reoccur.
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This is an editable document, so feel free to change the wording depending on your classroom management style. Also, there is a spot at the bottom of the form where you can include your phone number or email address for parents to contact you if they have any questions.