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Activity Form No.

My Personal Fitness Record

Personal Profile:

Name: Charmae Narvasa Course & Year: BSCE 1ST year


PE Schedule: Monday (1:00pm to 3:00pm) Name of Teacher: Mr. Dan Henly Cabrillos

Health/Fitness Profile:

Age : 18 (yrs) Resting Pulse Rate : _______83_______


(bpm)
Sex : Female Exercise Pulse Rate : _______110_______
(bpm)

Medical Record:
(As diagnosed by the university physician)

_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________

Anthropometric Measurements

DATE OF TEST: 1st Trial 2nd Trial 3rd Trial


HEIGHT 149 cm 150 cm 150 cm
SEATED HEIGHT 76 cm 76 cm 76 cm
ARM SPAN 155 cm 156 cm 156 cm

WEIGHT 43 kg 43 kg 43 kg

RELAXED ARM 23 cm 23 cm 23 cm
TENSED ARM 23.5 cm 23.5 cm 23.5
FOREARM 24 cm 24 cm 24 cm
CHEST 81 cm 81 cm 81 cm
WAIST 66 cm 66 cm 66 cm
HIP 81 cm 81 cm 81 cm
THIGH 54 cm 54 cm 54 cm
CALF 32 cm 32 cm 32 cm
ANKLE 21 cm 21 cm 21 cm

ATTESTED BY: _________Mr. Dan_____________________


DATE:_________________
PE Teacher

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