Escolar Documentos
Profissional Documentos
Cultura Documentos
Name of Parents*
Father: Mother:
Occupation: Occupation:
Contact no.: Contact no.:
(If living with a legal guardian) Name: Contact no.:
For Student-Athletes ONLY INTEREST related to Physical Ed.
**SPORTS Physical activities you usually do during free
Sports: time:
a) Singing; Genre: ___________________
**Position you play:
b) Dancing; Genre: ___________________
Current Team you are in: c) Swimming
Current Head Coach: d) Baking
e) Skateboarding
Number of years playing competitively: f) Running (Marathon)
**DANCE g) Trekking/Hiking
Name of dance troupe: h) Mountaineering
i) Camping
Dance Coach: j) Backpacking
Genre you are into: k) Picnic
Site 2 recent tournaments you have competed in: l) Bird-watching
Name of Tournament: m) Mountain Biking
n) Orienteering
Champion 1st runner-up 2nd runner-up o) Canyoneering
Rank: _______________________________________ p) Rock Climbing
q) Snorkeling
Special Award Received: r) Diving
s) Surfing
Name of Tournament: t) Canoeing
u) Kayaking
Champion 1st runner-up 2nd runner-up v) Sailing
Rank: _______________________________________ w) Fishing
Special Award Received: Others: __________________________
________________________________
1. In the past academic year, how active were you during your P.E class?
a. I did not join the P.E class.
b. I just stood/walked around during class.
c. I ran and played a bit.
d. I ran and played most of the time.
2. In the past week, how many days were you active for at least 60 minutes?
a. 0 b. 1 to 2 days c. 3 to 4 days d. 5 or more days
3. In the past week, how many days did you spend watching TV or playing video games for more than 2
hours?
a. 5 or more days b. 3 to 4 days c. 1 to 2 days d. 0
5. In the past week, how many hours (i.e., average) in a day did you spend playing video games or
surfing the net?
a. more than 4 hours b. 3 to 4 hours c. 1 to 2 hours d. less than an hour
6. In the past week, how many hours (i.e., total) of your weekend did you spend in moderate to high
intensity
activities?
a. more than 4 hours b. 3 to 4 hours c. 1 to 2 hours d. less than an hour
7. In the year, how many minutes (i.e., total) of your P.E class did you spend playing or dancing or
moving?
a. less than 15 mins b. 15 to 30 mins c. 31 to 45 mins d. more than 45 mins
8. In the past week, how would you classify your participation in various physical activities?
a. inactive b. lightly active c. moderately active d. very active
Score: ______________
HEROSAN A. DELA PEÑA, LPT Rating: ______________
Physical Education Teacher
This is to advise that a Student Deficiency Notice will be issued for every non-compliance of requirements for
Physical Education and Health (1, 2, 3, or 4). A verbal notice of non-compliance will also be issued prior to
this. Failure to comply may result to a failing grade but resolution may be accomplished by complying to the
prerequisite given by the teacher and be submitted on a given date.
_________________________________________
Signature Over Printed Name