PE 131 Contract
[Back to PE 131]
Name:__________________________________________________ Pre Contract
Grade:_____________________
Lab Day & Time:__________________________________________
Date:___________________________________________________ Post Contract Grade:
* With the Pre Contract please copy and attach text pages 25-26, 28, 45-46 and 79. Be sure to fill out #V., the goals and objectives related to the 'Wellness Lifestyle Questionaire', 'Dimensions of Wellness Scale', and 'Stages of Change Worksheet' at the top of page 4 of the contract.
** With the Post Contract please copy and attach text pages 79 (redone with
new RHR), 413, and 420 (With the right side test results completely filled out
from top to bottom). Surveys are as follows: Cardiovascular Risk p. 275-276;
Cancer Risk p. 313-314; Stress p. 331-332 and 335; if you answer yes on tobacco
use on page 420 do page 375 and 376 and turn in with post contract). Be sure
to fill out #VI., the goals and objectives related to the 'Wellness Scale' (p.
411, 413-414), at the bottom of page 4 of the contract.
I. Cardiovascular Assessment (text p. 53-54, and 61 table 3.8)
Test Used | Max V02 | Time | Classification | Objective | Date |
PRE CONTRACT GOAL: ___________________________________________________________
________________________________________________________________________________
SPECIFIC PLAN
1. ______________________________________________________________________________
2. ______________________________________________________________________________
3._______________________________________________________________________________
POST CONTRACT GOAL: _________________________________________________________
SPECIFIC PLAN
1.______________________________________________________________________________
2.______________________________________________________________________________
3.______________________________________________________________________________
II. Strength Endurance Assessment (text p. 117-119)
Bench Jump
|
Dips Or Push Ups
|
Crunch
|
Total | Fitness |
# / %
|
# / %
|
# / %
|
Points | Classification |
/
|
/
|
/
|
||
/
|
/
|
/
|
PRE CONTRACT GOAL:___________________________________________________________
________________________________________________________________________________
SPECIFIC PLAN
1.______________________________________________________________________________
2.______________________________________________________________________________
3.______________________________________________________________________________
POST CONTRACT GOAL:_________________________________________________________
SPECIFIC PLAN
1.______________________________________________________________________________
2.______________________________________________________________________________
3.______________________________________________________________________________
III. Flexibility Assessment (text p. 152-154, 156 tables 6.4 & 6.5)
R. Body Rotation
|
L. Body Rotation
|
Sit & Reach
|
Total
|
Flexibility
|
score / %
|
score / %
|
score / %
|
Points
|
Classification
|
PRE CONTRACT GOAL:___________________________________________________________
________________________________________________________________________________
SPECIFIC PLAN
1.______________________________________________________________________________
2.______________________________________________________________________________
3.______________________________________________________________________________
POST CONTRACT GOAL:_________________________________________________________
_______________________________________________________________________________
SPECIFIC PLAN
1._____________________________________________________________________________
2._____________________________________________________________________________
3._____________________________________________________________________________
IV. Body Composition Assessment (text p. 175-177, 184 table 7.9)
Test Used
|
% Body Fat
|
Date
|
PRE CONTRACT GOAL:___________________________________________________________
________________________________________________________________________________
SPECIFIC PLAN
1.______________________________________________________________________________
2.______________________________________________________________________________
3.______________________________________________________________________________
POST CONTRACT GOAL:_________________________________________________________
_______________________________________________________________________________
SPECIFIC PLAN
1.______________________________________________________________________________
2.______________________________________________________________________________
3.______________________________________________________________________________
V. * Pre Contract*: After completing and attaching the 'Wellness Lifesyle Questionaire'
(p. 25-26), the
'Dimensions of Wellness' (p. 28), and the 'Stages of Change Worksheet' (p. 45-46),
list at least two other
goals related to your answers here.
PRE CONTRACT GOAL:___________________________________________________________
________________________________________________________________________________
SPECIFIC PLAN
1.______________________________________________________________________________
2.______________________________________________________________________________
3.______________________________________________________________________________
PRE CONTRACT GOAL:___________________________________________________________
________________________________________________________________________________
SPECIFIC PLAN
1._______________________________________________________________________________
2._______________________________________________________________________________
3._______________________________________________________________________________
VI.** Post Contract list at least two or more other goals specifically related
to your answers to the
'Wellness Scale' (directions p. 411, form p. 413-414) here.
POST CONTRACT GOAL:__________________________________________________________
________________________________________________________________________________
SPECIFIC PLAN
1.______________________________________________________________________________
2.______________________________________________________________________________
3.______________________________________________________________________________
POST CONTRACT GOAL:_________________________________________________________
_______________________________________________________________________________
SPECIFIC PLAN
1.______________________________________________________________________________
2.______________________________________________________________________________
3.______________________________________________________________________________
POST CONTRACT GOAL:_________________________________________________________
_______________________________________________________________________________
SPECIFIC PLAN
1.______________________________________________________________________________
2.______________________________________________________________________________
3.______________________________________________________________________________