SAMPLE*


G.O.T.C.H.A.
“Get off the Couch Home Activity” Log
Student Physical Activity Log

Dear Parents/Guardians: It is our sincere hope that you will join us in an effort to improve your child’s physical fitness levels through encouraging physical activity. G.O.T.C.H.A. is meant to give kids an academic incentive to exercise, but it is our hope that the joy of physical activity will soon be his/her motivator. Thank you for participating in this important step to improving your child’s health.

Directions: You are to record after school activities on this calendar.
The
F.I.T.T. (frequency, intensity, type, time), fitness components (aerobic/ cardio-respiratory (AC), muscular strength/ endurance (MSE), flexibility (F) and body composition (BC)) and your personal goal plan will be your guide for filling in the log.

Name: _ Log: # Mod:_ Grade: _


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DAY**
DESCRIPTION OF ACTIVITY:
you participate in each day

Fitness Components:
Aerobic/ cardio-respiratory (AC)
Muscular Strength (MS)
Muscular Endurance (ME) Flexibility (F)
DURATION
(time in activity- DON’T INCLUDE BREAKS)
INTENSITY with
Heart Rate:
Light= below 125
Moderate= 126-165 Vigorous= 166-220

Take YOUR Heart Rate
LOCATION
(Home, school, park…)
SIGNATURE
(PARENT/ GUARDIAN)
(NO INITIALS)
MONDAY
Date:







TUESDAY
Date:







WEDNESDAY
Date:







THURSDAY
Date:







FRIDAY
Date:







SATURDAY
Date:







SUNDAY
Date:**