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HEALTH AND ACTIVITY RECORD

GENERAL INFORMATION
Aadhar Card No. of student___________________________________

Name____________________________________________________

Admission No._____________________ DOB ___________________

M F T __________ BLOOD GROUP__________

Mother’s Name: ____________________________________________

YOB_____________ weigh t_______________ height___________ Blood Group_______

Father’s Name : ____________________________________________

YOB_____________ weight _______________ height___________ Blood Group_______

Family Monthly Income : ____________________________

Address : _________________________________________________________________

__________________________________________________________________________

____________________________________

Phone No. _____________________ Mobile : ____________________

CWSN, Specify ______________________________________________

Signature of Parents/Guardian Date ___________


Name__________________ Roll No.____________ Class_________________

Fitness Fitness Parameter Test Name Scoring Scoring Scoring Scoring


Component
Health component Body Composition BMI

Muscular Strength Partial Curl up

Flexed/Bent arm
hang
Flexibility Sit and reach

Endurance 600m run

Balance Flamingo balance


test
Skill Component Agility Shuttle run

Speed Sprint/dash

Power Standing vertical


jump
Coordination Plate tapping

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