I created this to help those students who need assistance with staying in their seats. If a student gets out of their chair without permission, they must put a check in the first box and write their initials in the second box. If they do it again, they put a check and initial. They get three "move arounds" during the day without a consequence. The next day, they are given a new pass. I have found that this gives students the chance to improve their performance/make a goal to work towards each day.