1. Republic of the Philippines
Region I
DIVISION OF ILOCOS SUR
Bantay, Ilocos Sur
PHYSICAL FITNESS TEST FORM
Name:_______________________________________ Birth date:______________ Age:_______ Gender: _______
(Family Name)(Given Name)(Middle Name) (Month/Day/Year) (Current Age) (Male/Female)
Grade/Year & Section: ________________________________ Teachers Name: _____________________________
School: ________________________________________________________________________________________
Address & Cell phone No.: _________________________________________________________________________
PART I - HEALTH-RELATED FITNESS TEST
A. BODY COMPOSITION
1. Body Mass Index (BMI)
Height
(in centimeter)
Weight
(in pounds)
Body Mass Index
(BMI)
Classification
2. Waist Circumference
Waist Circumference
(centimeter) Interpretation
A. CARDIOVASCULAR ENDURANCE: 3-Minute Step
Heart Rate per Minute
Resting Heart Rate Training Heart Rate
B. MUSCULAR STRENGTH
1. 90 Degrees Push 2. Curl-up
Number of Push-up Number of Curl-up
C. FLEXIBILITY
1. Zipper Test 2. Sit and Reach
Overlap (in centimeter) Score Overlap (in centimeter) Score Score in centimeter
Right Arm Up Left Arm Up
PART II - SKILL-RELATED FITNESS TEST
A. SPEED : 40 meter sprint
TIME (00:00)
A. POWER:
1. Basketball Pass 2. Standing Long Jump
Distance (in meter) Distance (in centimeter)
1st
Trial 2nd
Trial 3rd
Trial 1st
Trial 2nd
Trial
B. AGILITY : Hexagon Agility Test
Clockwise (Time) Counter Clockwise (Time) Average (Time)
C. REACTION TIME: Stick Drop Test
1st
Trial 2nd
Trial 3rd
Trial Middle Score
D. COORDINATION: Paper Juggling
First Trial: Number of Hits Second Trial: Number of Hits
E. BALANCE: Stork Balance Stand Test
First Trial: TIME (00:00) Second Trial: TIME (00:00)
_________________________________
Signature of Participant
