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Health and Activity Card

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380 views3 pages

Health and Activity Card

Uploaded by

sagarsarkar0521
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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SHIVEDALE SCHOOL

JAGJEETPUR, KANKHAL, HARDWAR


HEALTH AND ACTIVITY CARD
GENERAL INFORMATION

Name of the Student: ______________________________________________________________


Admission No.: __________________________ Class Roll No.: ____________________
Date of Birth: ___________________________ Blood Group: _____________________
Email: _________________________________ Gender: __________________________
Aadhar Card No. of Student (optional): _________________________________________________
CWSN, Specify: ___________________________________________________________________

Mother’s Name: __________________________________________________________________


Aadhar Card No.(optional): _________________________ Blood Group: _____________________

Father’s Name: ___________________________________________________________________


Aadhar Card No.(optional): _________________________ Blood Group: _____________________

Family Monthly Income: ____________________________________________________________


Residential Address: ________________________________________________________________
_________________________________________________________________________________
Office Address: ____________________________________________________________________
_________________________________________________________________________________
Phone / Mobile No. (F): ___________________________ (M): ____________________________

Signature of Father: _____________________________ Date: ____________________________

Signature of Mother: _____________________________ Date: ____________________________


HEALTH AND ACTIVITY RECORD

(To be filled with Consultation & Concerned Doctor & Parents)

Components Parameters Measurements / Parameters Measurements /


Readings Readings
Vision Right Eye Left Eye

Ears Right Ear Left Ear

Teeth Occlusion Caries & Gums Tonsils

General Body Height (Meters) Weight (Kg)


Measurements
Circumferences Hip (Inches) Waist (Inches)

Health Status Pulse (Per Minute) Blood Pressure

Signature of Doctor: _____________________ Signature of Parents: _______________________


Date: __________________________________ Date: ____________________________________

(To be filled by Physiotherapist)

Posture Evaluation If any: (Please tick √)

Head Forward Tilted Head


Sunken Chest Shoulders Uneven
Round Shoulders Scoliosis
Kyphosis Flat Feet
Lordosis Knock Knees

Abdominal Ptosis Bow Legs

Body Lean

Signature of Doctor: ______________________ Date: ______________________________


(To be filled by Physical Education Teachers)

Fitness Fitness Parameters Test Name What does it Measure Measurement/


Components Score
Body BMI Body Mass Index for specific
Composition Age and Gender
Muscular Core Partial Curl Abdominal Muscular
Strength Endurance
Upper Push Up Muscular Endurance
Health Body
Components Flexibility Sit and Measures the flexibility of the
Reach lower back and hamstring
muscles
Endurance 600 Metres Cardiovascular Fitness/
Run Cardiovascular Endurance
Balance Static Flamingo Ability to balance
Balance Balance Test successfully on a single leg
Agility Shuttle Run Test of speed and agility

Speed Sprint/ Dash Determines acceleration and


speed
Skill Power Standing Measures the Leg Muscle
Vertical Power
Components
Jump
Coordination Plate Tests speed and coordination
Tapping of limb movement
Alternative Measures hand-eye
Hand Wall coordination
Toss Test

Component Parameters Remarks

Sporting Activities Strand 1: Any one of the following:


(HPE) 1. Athletics/Swimming
2. Team Game
3. Individual Game
4. Adventure Sports
Strand 2: Health and Fitness
(Mass PT, Yoga, Dance, Calisthenics,
Jogging, Cross Country Run, Working outs
using weights/gym equipment, Tai-Chi etc.

Strand 3: SEWA

Signature of P.Ed. Teacher: ______________________ Date: ______________________________

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