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Personal Physical Activity Plan Template

The student has created a personal physical activity plan that includes the physical activities of indoor soccer and inline skating. For indoor soccer, the plan specifies 3 practices and 1 game per week, totaling 5 hours and 30 minutes. For inline skating, the plan is to skate 5 days a week to and from school, totaling 3 hours and 20 minutes. The student has assigned each activity a risk factor rating and included required safety checklists. The teacher has signed the plan, acknowledging the student has met the criteria for developing a safe physical activity plan and is aware of managing risks associated with the planned activities.

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Faxman Cavan Singco
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96 views1 page

Personal Physical Activity Plan Template

The student has created a personal physical activity plan that includes the physical activities of indoor soccer and inline skating. For indoor soccer, the plan specifies 3 practices and 1 game per week, totaling 5 hours and 30 minutes. For inline skating, the plan is to skate 5 days a week to and from school, totaling 3 hours and 20 minutes. The student has assigned each activity a risk factor rating and included required safety checklists. The teacher has signed the plan, acknowledging the student has met the criteria for developing a safe physical activity plan and is aware of managing risks associated with the planned activities.

Uploaded by

Faxman Cavan Singco
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd

RM 5–PA: Personal Physical Activity Plan

Name       Class       Date      

Physical Activity Frequency of Estimated Risk Safety


Activity Time Factor Checklists
(Hours and Rating Included
Minutes) (RFR)
Examples Indoor Soccer 3 practices + 1 game 5 hrs. 30 min. 2 Yes
per week
Inline Skating 5 days—to and from 3 hrs. 20 min. 2 Yes
school
                      
                      
                      
                      
                      
                      
                      
                      
                      
                      

Student Comments      

Teacher Comments      

___________________________________ ________________________________
Teacher Signature Date

The teacher’s signature is an acknowledgement of the following:


 The student has met the criteria for formulating his or her personal physical activity plan.
 The student has demonstrated an understanding of how to manage risk and take appropriate steps to
participate safely in physical activity.
 The student is aware of the safety guidelines information and associated responsibilities for discussion
with and approval by his or her parent/guardian.

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