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Name: Short Term Goal Long Term Goal

DATE

TYPEOF ACTIVITY or ACTIVITIES

TOTAL MINUTES OF ACTIVITY

INTENSITY DATE (1,2,or3 basedon chart below)

TYPEOF ACTIVITY or ACTIVITIES

TOTAL MINUTESOF ACTIVITY

INTENSITY (1,2,or3 basedon chart below)

Types of Activities (write the # in the columns)


1. Team Sports: baseball/softball, basketball, football, water polo, soccer, cheerleading, rowing 2. Individual Sports: golf, wrestling, swimming, martial arts, weight training, gymnastics 3. Fitness Activities: running, walking, dancing, yoga/pilates, biking, tennis, skateboarding, aerobics 4. PE class: I am currently enrolled in AHS PE class 5. Other: Please fully explain in Activity Column if you have participated in other activities

Intensity Levels

Level 1: Low exertion, little or no perspiration. Little


increase in heart rate/breathing Ex: walking to bus

Level 2: Able to speak without gasping for air,


beginning of light perspiration

Level 3: Sweating profusely and breathing heavily

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