jess in white
Health Survey Complete all health and fitness status questions. Ask for assistance from your parents or guardians if needed. Personal Information
Height 5’,2”
Weight 115 lbs
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. Describe two or more physical activities you participate in outside of a school setting. They could be within your city, community, neighborhood or family. Include how often you participate, such as a daily or weekly basis.
Soccer – Twice weekly
Skating – Twice weekly
4. Explain how your friends positively and negatively influence your decisions to be physically active and to make healthy choice
They influence me positively because most of my friend are healthy so I choose better things to eat
5. What areas of your health and body would you like to improve? ___x__ Flexibility ___x_ Cardiovascular endurance ___x__ Upper body strength ___x__ Lower body strength _____ Body composition _____ Increase weight _____ Decrease weight ___x__ 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. I would like to see a list of the top recommended foods that are high in vitamins like a weekly list
B. Text Message Alerts
C. My Pace
Height 5’,2”
Weight 115 lbs
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. Describe two or more physical activities you participate in outside of a school setting. They could be within your city, community, neighborhood or family. Include how often you participate, such as a daily or weekly basis.
Soccer – Twice weekly
Skating – Twice weekly
4. Explain how your friends positively and negatively influence your decisions to be physically active and to make healthy choice
They influence me positively because most of my friend are healthy so I choose better things to eat
5. What areas of your health and body would you like to improve? ___x__ Flexibility ___x_ Cardiovascular endurance ___x__ Upper body strength ___x__ Lower body strength _____ Body composition _____ Increase weight _____ Decrease weight ___x__ 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. I would like to see a list of the top recommended foods that are high in vitamins like a weekly list
B. Text Message Alerts
C. My Pace