Physical Activity Log Sheet

ADVERTISEMENT

Physical Activity
Log
Directions: Fill out the form and bring it back to class.
Encourage others in your family to also participate. Consider keeping track for one month.
DUE DATE ________________________________________________________________________________________
NAME ___________________________________________________________________________________________
GRADE _______________________________________ CLASS PERIOD _______________________________________
Week 1
Week 2
Date: _________
Date: _________
Monday: 20 Push-ups & 25 Curl-ups
___
Monday: 20 Push-ups & 25 Curl-ups
___
Tuesday: Choice activity: __________# min. ___
Tuesday: Choice activity: __________# min. ___
Wednesday: 20 Push-ups & 25 Curl-ups
___
Wednesday: 20 Push-ups & 25 Curl-ups
___
Thursday: Choice activity: _________# min. ___
Thursday: Choice activity: _________# min. ___
Friday: 20 Push-ups & 25 Curl-ups
___
Friday: 20 Push-ups & 25 Curl-ups
___
Guardian Signature: _______________________
Guardian Signature: _______________________
Week 3
Week 4
Date: _________
Date: _________
Monday: 20 Push-ups & 25 Curl-ups
___
Monday: 20 Push-ups & 25 Curl-ups
___
Tuesday: Choice activity: __________# min. ___
Tuesday: Choice activity: __________# min. ___
Wednesday: 20 Push-ups & 25 Curl-ups
___
Wednesday: 20 Push-ups & 25 Curl-ups
___
Thursday: Choice activity: _________# min. ___
Thursday: Choice activity: _________# min. ___
Friday: 20 Push-ups & 25 Curl-ups
___
Friday: 20 Push-ups & 25 Curl-ups
___
Guardian Signature: _______________________
Guardian Signature: _______________________
Choice Activity must be an exercise that raises heart rate, minimum time of 30 minutes. Suggestions: walking, jogging, biking, skating,
inline skating, skateboarding, swimming, sports (basketball, soccer, hockey, etc.)
If you make a different choice, write it here. Make sure that your teacher approves it before you begin using the activity on your chart.
My Special Choice Activity is: __________________________

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Miscellaneous
Go