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PE 34 Physical Activities Towards Health and Fitness (PATH FIT-II)

SWIMMING MONITORING RECORD

Personal Profile:

Name: ____________________________________________ Age: __________ Latest Photo Picture

Section Code : __________________Class Schedule: _______ Gender: _______ 2x2


PE 34 Instructor: April Rose M. Castro Height: ________
Religious affiliation: ______________________________ Weight: _______
Medical Conditions
⃞ Allergies ⃞ Burns ⃞ Minor/major operation Other(Specify): ________________
____________ __________ __________________
⃞ Physical deformities (Specify): ____________________________________________________
⃞ Aquatic/Swimming Phobia (Specify):______________________________________________
⃞ Aquatic/Swimming Involvement/Club (Specify):______________________________________

Physical Activity Readiness Questionnaire (PAR-Q)

SWIMMING STUDENT SKILLS STATUS

⃞ Novice/Beginner ⃞ Intermediate ⃞ Advance/Competitive ⃞ Sinker ⃞ Floater

Date: ______________________ __________________________


__________________________ Student Signature:
Instructor Signature

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