Carmenza
Health Survey To provide information regarding current health and fitness status, complete the items below. Ask for assistance from your parents or guardians if needed. Be sure to complete all of the areas of the questionnaire completely. Personal Information
Height __5'7"______
Weight ___115_____ Health Status 1. Yes_____ No__X____ Do you have any medical situation that would limit your participation in any physical activity?
*If yes, please write a detailed explanation of the medical issue and the specific activities you cannot participate in.
2. Rate your present medical condition: X Excellent _____ Good _____ Fair _____ Poor *If you selected Fair or Poor and you do not have a condition that is explained in item #1, explain why you have rated yourself in this way.
3. Think about any physical activities that you participate in outside of a school setting. They could be within your city, community, neighborhood or family. Describe two or more of these physical activities. I go to the local gym. I also run every other morning before school.
4. Please list any activities or sports that you participate in on a weekly basis. None. 5. What areas of your health and body would you like to improve? __X_ Flexibility _____ Cardiovascular endurance _X__Upper body strength X Lower body strength _____ Body composition _X__ Increase weight _____ Decrease weight _____ Decrease percentage of body fat __X__ Increase physical activity level
6. Go to the course Announcement page. List three things from the Announcement page content that you will use to help you succeed in your Personal Fitness course OR three things that you would like to see on your course Announcement page which might be beneficial to you.
A. Teacher contact information
B. Pace chart
C. Personal Fitness text message
Height __5'7"______
Weight ___115_____ Health Status 1. Yes_____ No__X____ Do you have any medical situation that would limit your participation in any physical activity?
*If yes, please write a detailed explanation of the medical issue and the specific activities you cannot participate in.
2. Rate your present medical condition: X Excellent _____ Good _____ Fair _____ Poor *If you selected Fair or Poor and you do not have a condition that is explained in item #1, explain why you have rated yourself in this way.
3. Think about any physical activities that you participate in outside of a school setting. They could be within your city, community, neighborhood or family. Describe two or more of these physical activities. I go to the local gym. I also run every other morning before school.
4. Please list any activities or sports that you participate in on a weekly basis. None. 5. What areas of your health and body would you like to improve? __X_ Flexibility _____ Cardiovascular endurance _X__Upper body strength X Lower body strength _____ Body composition _X__ Increase weight _____ Decrease weight _____ Decrease percentage of body fat __X__ Increase physical activity level
6. Go to the course Announcement page. List three things from the Announcement page content that you will use to help you succeed in your Personal Fitness course OR three things that you would like to see on your course Announcement page which might be beneficial to you.
A. Teacher contact information
B. Pace chart
C. Personal Fitness text message