Medical Clearance Form Page 3
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4Push-Ups
Your hands will be placed on the floor, slightly wider than shoulder width apart. Start in the up position
with your elbows fully extended, feet no more than 12 inches apart, and your weight supported by your
arms and toes. You must keep your back straight at all times and lower your upper body to come within a
closed fist distance of the ground then return to the up position with arms fully extended to be counted as a
proper push-up. Resting must be done in the UP position. If you rest in the down position, this component
of the test will be terminated. This test is not timed.
Score
Range
-2
12 and below
-1
13-14
0
15-16
1
17-20
2
21-24
3
25-28
4
29-34
5
35-40
6
41-46
7
47-53
8
54-60
9
61-67
10
68 and over
Sit-Ups
Your feet will be held down with your monitor's hands or knees. Your legs may not be held behind your
calves. Your hips must remain on the floor at all times (do not lift your hips off the floor to gain
momentum). Your shoulder blades must touch the floor between each repetition. In the up position, you
will touch your elbows to your knees or thighs and return down until your shoulder blades touch the floor
(your hands must stay in contact with your shoulders/chest at all times). This will count as one sit-up. This
is a ONE MINUTE timed test.
Score
Range
-2
16 and below
-1
17-18
0
19-21
1
22-25
2
26-29
3
30-33
4
34-37
5
38-41
6
42-45
7
46-49
8
50-53
9
54-57
10
58and over
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Parent category: Medical