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P.E Medical Form

This document contains forms for a medical clearance and individual records for physical fitness pre-testing at Quezonian Educational College. The medical clearance form must be submitted by the student and signed by the examining physician indicating whether the student is able or not able to participate. The individual records form collects a student's name, test results, and pulse count for 9 different physical fitness tests administered as part of pre-testing.

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Eunice Almeyda
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1K views1 page

P.E Medical Form

This document contains forms for a medical clearance and individual records for physical fitness pre-testing at Quezonian Educational College. The medical clearance form must be submitted by the student and signed by the examining physician indicating whether the student is able or not able to participate. The individual records form collects a student's name, test results, and pulse count for 9 different physical fitness tests administered as part of pre-testing.

Uploaded by

Eunice Almeyda
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Quezonian Educational College Inc. Quezonian Educational College Inc.

INDIVIDUAL RECORD FORMS


MEDICAL CLEARANCE FORM (Physical Fitness Pre-Testing)
(To be accomplished by the school physician prior to the testing period)
Note : Medical clearance form is required.
INDIVIDUAL RECORD FORMS
NOTE: This form should be submitted by the student before administering the (Pre-test)
Physical Fitness Test.

This is to protect the teacher from being blamed for any accident such NAME _________________________________________ Group No. ___________
as fainting, injuries and the like.
Test Items Results/Score

Test # 1
___________________ Standing Long Jump __________________
Date
Test # 1
Name _______________ College ___________ Course/Major __________________ Bent- Knee Curl Up __________________

Sex ______ Age _______ Height _________ centimeters Weight _______ kilogram Test # 3
50 Meter Sprint __________________

Test # 4 (Males)
This individual is Physically [ ] able
Regular Push Up __________________
[ ] not able
Test # 5
to participate in physical education class activities and physical fitness testing. Knee Push Ups __________________

Test # 6
Shuttle Run __________________

_________________________ Test # 7
Examining Physician Sit and Reach __________________

Noted : Test # 8
1000 Meter Run __________________

_________________________ Test # 9
3 Minute Step Test __________________
PE Instructor
Pulse Count : ________
PEI ________________

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