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.______________________________________________________________________________