CONGREGATION OF DOMINICAN SISTERS OF ST.

CATHERINE OF SIENA
NOTRE DAME-SIENA COLLEGE OF GENERAL SANTOS CITY
PUROK MASAGANA, NLSA EXTENSION ROAD, SAN ISIDRO, GENERAL SANTOS CITY

S.Y. 2018-2019
Physical Education
Wqwdnjqw& Health
k 11

Fitness Contract

I have realized that my sedentary behaviour may lead to several lifestyle diseases and I am determined to
adopt an active lifestyle. I will follow my exercise program starting on ______________ and I intend to
keep it until I achieve the following goals:
Short-term Goals
Target Date: _____________
1. ___________________________________________________________________________
___________________________________________________________________________

Target Date: _____________

2. ___________________________________________________________________________
___________________________________________________________________________

Target Date: _____________

3. ___________________________________________________________________________
___________________________________________________________________________

These short-term goals will help me achieve my LONG-TERM GOAL:

Target Date: ___________________
_____________________________________________________________________________________

For fulfilling my end of the contract, I want this as my reward:

Target Date: __________________
_____________________________________________________________________________________

With the help of my partner ________________________________, I intend to improve my health by

adopting an active lifestyle.

My Complete Name & Signature: ______________________________________

Partner’s Complete Name & Signature: _________________________________
 Physical Activity Readiness Questionnaire (PAR-Q)
The DOH recommends that Filipinos participate in moderate to vigorous physical activities for at
least 30 minutes for most days of the week. Physical activity is good for the heart and strengthens the
body. Since physical activity is safe for most people, everyone is encouraged to pursue an active lifestyle.
This questionnaire will help you check if moderate to vigorous physical activity is safe for you. Put a
check mark on the box that corresponds to your answer. If you answer “No” to all the questions, you are
ready to engage in an active lifestyle. Start an exercise program that has low to moderate intensity
activities and build your intensity gradually. If “Yes” to any question, you need to talk to your physician
about your condition before participating in an exercise program.

Question Yes No

1. Has your doctor ever told you that you have a heart
condition or a high blood pressure?

2. Do you feel pain in your chest when you are doing your
daily activities or when you do physical activities?

3. Do you lose balance because of dizziness or have you lost

consciousness in the past 12 months?

4. Have you ever diagnosed with chronic condition other than

heart disease or hypertension (i.e., cancer)?

5. Are you currently taking prescribed maintenance

medications?

6. Do you currently have a bone, joint, or other

musculoskeletal condition that can worsen as a result of
moderate to vigorous physical activity?

7. Has your doctor ever told you that you should only engage
in medically supervised physical activity?

_____________________________________
Student’s Complete Name & Signature

____________________________________
Parent’s Complete Name & Signature
Evidences/ Documentations:
Paste/ attached here the Index Cards of your Fitness Level Output:
Evidences/ Documentations:
My Healthy Lifestyle Reflection:
Pictures with caption: