Physical Fitness Development Form

Category: ____ Date Started: _________

Note: Please attached to the back of this paper your scanned copy of your timeline goals.

Name: Gapoy, Frednixen B. Year and Section: Age:

Date of Birth: Height: Gender:

Date (Program Started): Weight: BMI:

Latest PFT result:

SMART Goal (Specific, Measurable, Attainable, Relevant, Time-bounded)

To be able to improve my pull-up from 4-10 at the end of week 12.

Quota based:
To be able to perform 100 push-up every week.
To be able to perform 100 sit-up every week.

Week 1 Week 2 Week 3 Week 4 Week 5 Week 6

GOAL
Weight: Weight: Weight: Weight: Weight: Weight:
Pull-up Goal:100 Goal:100 Goal:100 Goal:100 Goal:100 Goal:100
Passing 5 Score:4 Score:4 Score:3 Score:3 Score:2 Score:2
Pull-up Goal:10 Goal:10 Goal:10 Goal:10 Goal:10 Goal:10
Passing 5 Score:4 Score:4 Score:3 Score:3 Score:2 Score:2
Push-up Goal:43 Goal:43 Goal:43 Goal:43 Goal:43 Goal:43
(2min) Score:35 Score:36 Score:37 Score: Score: Score:
Passing 43

Sit-up Goal: Goal: Goal: Goal: Goal: Goal:

Passing 43 Score: Score: Score: Score: Score: Score:
3.2 km Run Goal: Goal: Goal: Goal: Goal: Goal:
Passing Score: Score: Score: Score: Score: Score:
22mins
Lose Goal:67Kg Goal:67Kg Goal:67Kg Goal:67Kg Goal:67Kg Goal:67Kg
Weight Score:72Kg Score: Score: Score: Score: Score:
Average
Rating
 Week 7 Week 8 Week 9 Week 10 Week 11 Week 12
Events
Weight: Weight: Weight: Weight: Weight: Weight:
Pull-up Goal:10 Goal:10 Goal:10 Goal:10 Goal:10 Goal:10
Passing 5 Score: Score: Score: Score: Score: Score:
Push-up Goal: Goal: Goal: Goal: Goal: Goal:
(2min) Score: Score: Score: Score: Score: Score:
Passing 43
Sit-up Goal: Goal: Goal: Goal: Goal: Goal:
Passing 43 Score: Score: Score: Score: Score: Score:
3.2 km Run Goal: Goal: Goal: Goal: Goal: Goal:
Passing Score: Score: Score: Score: Score: Score:
22mins
Average
Rating

Signature over printed name