DAILY PHYSICAL ACTIVITY FORM – GR 12

Name: _____________________________________ Grade_______________________

Student Number: _____________________________ Phone Number: ______________

Semester ONE – September to January

I have completed 150 minutes of Daily Physical Activity each

week for this semester.

I have NOT completed 150 minutes of Daily Physical Activity

each week for this semester.

I am currently taking PE

I have a medical exemption – must be approved by Mr.

Robinson or Mr. Younger

Please list examples of the activities that you have done to meet
your Daily Physical Activity requirement – must be completed

_____________________ __________________________ __________________

Student Signature Parent Signature Date

Must be returned to Mr. Robinson by December 3, 2010 – turn over for Semester 2
 DAILY PHYSICAL ACTIVITY FORM – GR 12
Name: _____________________________________ Grade_______________________

Student Number: _____________________________ Phone Number: ______________

Semester TWO – February to June

I have completed 150 minutes of Daily Physical Activity each

week for this semester.

I have NOT completed 150 minutes of Daily Physical Activity

each week for this semester.

I am currently taking PE

I have a medical exemption – must be approved by Mr.

Robinson or Mr. Younger

Please list examples of the activities that you have done to meet
your Daily Physical Activity requirement – must be completed

_____________________ __________________________ __________________

Student Signature Parent Signature Date

Must be returned to Mr. Robinson by May 6, 2011 – turn over for Semester 1