Fitness Journey
 


How Active Is Your Child?

Aloha! Please respond to each question as best as you can for each child. Mahalo (Thank you).

Parent's First Name:
Parent's Last Name:
Email Address:
Address:
City:
State:
Country:
Zip/Postal Code:
Phone Number:
Fax Number:
 
Child's Name:
Child's Age:
Child's Name:
Child's Age:
Child's Name:
Child's Age:
Child's Name:
Child's Age:
Child's Name:
Child's Age:
Child's Name:
Child's Age:
How many minutes of physical education does your child get each week?
Does your child/children have any special needs?
Does your child participate in a community-based fitness activity?
How many hours a week does your child participate in one or more of the following:
 
Aerobic dance
Badminton
Basketball
Baseball
Bicycling
Calisthenics
Diving
Football
Golf
Gymnastics
Hiking/backpacking
Horseback riding
Jumping rope
Martial arts
Paddling
Rodeo
Roller hockey
Running
Skating
Skiing
Soccer
Softball
Swimming
Table tennis
Tennis
Track and field
Volleyball
Walking
Weight lifting
Wrestling
How many hours a day does your child watch TV, play video games, or is on the computer?
Do you think your child is fit?
Does your child think he or she is fit?
Additional Comments:


 


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