NAME: ___Bishr____________________________ HR: _____

Month:

September

List all physical activities participated in during the day.

Remember that students need to participate in a minimum of 30 minutes per day. Each activity must last at least 10 minutes.

Example: Dance class (70 min), walked at lunch (20 min), Soccer practice (80 min) Total

Minutes

Ex:

170 min

Week # 1

(Please Circle)

Met/ Not Met

___________

(HRT initials) M P.E. 75

T

W P.E. 75

Th

F P.E. 75

Week # 2

(Please Circle)

Met/ Not Met

___________

(HRT initials) M

T P.E. 75

W

Th P.E. 75

F

Week # 3

(Please Circle)

Met/ Not Met

___________

(HRT initials) M P.E. 75

T

W P.E. 75

Th

F P.E. 75

Week # 4

(Please Circle)

Met/ Not Met

___________

(HRT initials) M

T P.E. 75

W

Th P.E. 75

F

Week # 5

(Please Circle)

Met/ Not Met

___________

(HRT initials) M P.E. 75

T

W P.E. 75

Th

F P.E. 75

The student has MET/ NOT MET the DPA requirements for the above month.

HR Teacher Signature: _____________________________

NAME: ___Bishr____________________________ HR: _____

Month:

October

List all physical activities participated in during the day.

Remember that students need to participate in a minimum of 30 minutes per day. Each activity must last at least 10 minutes.

Example: Dance class (70 min), walked at lunch (20 min), Soccer practice (80 min) Total

Minutes

Ex:

170 min

Week # 1

(Please Circle)

Met/ Not Met

___________

(HRT initials) M P.E. 75

T

W P.E. 75

Th

F P.E. 75

Week # 2

(Please Circle)

Met/ Not Met

___________

(HRT initials) M

T P.E. 75

W

Th P.E. 75

F

Week # 3

(Please Circle)

Met/ Not Met

___________

(HRT initials) M P.E. 75

T

W P.E. 75

Th

F P.E. 75

Week # 4

(Please Circle)

Met/ Not Met

___________

(HRT initials) M

T P.E. 75

W

Th P.E. 75

F

Week # 5

(Please Circle)

Met/ Not Met

___________

(HRT initials) M P.E. 75

T

W P.E. 75

Th

F P.E. 75

The student has MET/ NOT MET the DPA requirements for the above month.

HR Teacher Signature: _____________________________

NAME: ___Bishr____________________________ HR: _____

Month:

November List all physical activities participated in during the day.

Remember that students need to participate in a minimum of 30 minutes per day. Each activity must last at least 10 minutes.

Example: Dance class (70 min), walked at lunch (20 min), Soccer practice (80 min) Total

Minutes

Ex:

170 min

Week # 1

(Please Circle)

Met/ Not Met

___________

(HRT initials) M P.E. 75

T

W P.E. 75

Th

F P.E. 75

Week # 2

(Please Circle)

Met/ Not Met

___________

(HRT initials) M

T P.E. 75

W

Th P.E. 75

F

Week # 3

(Please Circle)

Met/ Not Met

___________

(HRT initials) M P.E. 75

T

W P.E. 75

Th

F P.E. 75

Week # 4

(Please Circle)

Met/ Not Met

___________

(HRT initials) M

T P.E. 75

W

Th P.E. 75

F

Week # 5

(Please Circle)

Met/ Not Met

___________

(HRT initials) M P.E. 75

T

W P.E. 75

Th

F P.E. 75

The student has MET/ NOT MET the DPA requirements for the above month.

HR Teacher Signature: _____________________________

NAME: ___Bishr____________________________ HR: _____

Month:

December

List all physical activities participated in during the day.

Remember that students need to participate in a minimum of 30 minutes per day. Each activity must last at least 10 minutes.

Example: Dance class (70 min), walked at lunch (20 min), Soccer practice (80 min) Total

Minutes

Ex:

170 min

Week # 1

(Please Circle)

Met/ Not Met

___________

(HRT initials) M P.E. 75

T

W P.E. 75

Th

F P.E. 75

Week # 2

(Please Circle)

Met/ Not Met

___________

(HRT initials) M

T P.E. 75

W

Th P.E. 75

F

Week # 3

(Please Circle)

Met/ Not Met

___________

(HRT initials) M P.E. 75

T

W P.E. 75

Th

F P.E. 75

Week # 4

(Please Circle)

Met/ Not Met

___________

(HRT initials) M

T P.E. 75

W

Th P.E. 75

F

Week # 5

(Please Circle)

Met/ Not Met

___________

(HRT initials) M P.E. 75

T

W P.E. 75

Th

F P.E. 75

The student has MET/ NOT MET the DPA requirements for the above month.

HR Teacher Signature: _____________________________

NAME: ___Bishr____________________________ HR: _____

Month:

January

List all physical activities participated in during the day.

Remember that students need to participate in a minimum of 30 minutes per day. Each activity must last at least 10 minutes.

Example: Dance class (70 min), walked at lunch (20 min), Soccer practice (80 min) Total

Minutes

Ex:

170 min

Week # 1

(Please Circle)

Met/ Not Met

___________

(HRT initials) M P.E. 75

T

W P.E. 75

Th

F P.E. 75

Week # 2

(Please Circle)

Met/ Not Met

___________

(HRT initials) M

T P.E. 75

W

Th P.E. 75

F

Week # 3

(Please Circle)

Met/ Not Met

___________

(HRT initials) M P.E. 75

T

W P.E. 75

Th

F P.E. 75

Week # 4

(Please Circle)

Met/ Not Met

___________

(HRT initials) M

T P.E. 75

W

Th P.E. 75

F

Week # 5

(Please Circle)

Met/ Not Met

___________

(HRT initials) M P.E. 75

T

W P.E. 75

Th

F P.E. 75

The student has MET/ NOT MET the DPA requirements for the above month.

HR Teacher Signature: _____________________________

NAME: ___Bishr____________________________ HR: _____

Month:

February

List all physical activities participated in during the day.

Remember that students need to participate in a minimum of 30 minutes per day. Each activity must last at least 10 minutes.

Example: Dance class (70 min), walked at lunch (20 min), Soccer practice (80 min) Total

Minutes

Ex:

170 min

Week # 1

(Please Circle)

Met/ Not Met

___________

(HRT initials) M P.E. 75

T

W P.E. 75

Th

F P.E. 75

Week # 2

(Please Circle)

Met/ Not Met

___________

(HRT initials) M

T P.E. 75

W

Th P.E. 75

F

Week # 3

(Please Circle)

Met/ Not Met

___________

(HRT initials) M P.E. 75

T

W P.E. 75

Th

F P.E. 75

Week # 4

(Please Circle)

Met/ Not Met

___________

(HRT initials) M

T P.E. 75

W

Th P.E. 75

F

Week # 5

(Please Circle)

Met/ Not Met

___________

(HRT initials) M P.E. 75

T

W P.E. 75

Th

F P.E. 75

The student has MET/ NOT MET the DPA requirements for the above month.

HR Teacher Signature: _____________________________

NAME: ___Bishr____________________________ HR: _____

Month:

March

List all physical activities participated in during the day.

Remember that students need to participate in a minimum of 30 minutes per day. Each activity must last at least 10 minutes.

Example: Dance class (70 min), walked at lunch (20 min), Soccer practice (80 min) Total

Minutes

Ex:

170 min

Week # 1

(Please Circle)

Met/ Not Met

___________

(HRT initials) M P.E. 75

T

W P.E. 75

Th

F P.E. 75

Week # 2

(Please Circle)

Met/ Not Met

___________

(HRT initials) M

T P.E. 75

W

Th P.E. 75

F

Week # 3

(Please Circle)

Met/ Not Met

___________

(HRT initials) M P.E. 75

T

W P.E. 75

Th

F P.E. 75

Week # 4

(Please Circle)

Met/ Not Met

___________

(HRT initials) M

T P.E. 75

W

Th P.E. 75

F

Week # 5

(Please Circle)

Met/ Not Met

___________

(HRT initials) M P.E. 75

T

W P.E. 75

Th

F P.E. 75

The student has MET/ NOT MET the DPA requirements for the above month.

HR Teacher Signature: _____________________________

NAME: ___Bishr____________________________ HR: _____

Month:

April

List all physical activities participated in during the day.

Remember that students need to participate in a minimum of 30 minutes per day. Each activity must last at least 10 minutes.

Example: Dance class (70 min), walked at lunch (20 min), Soccer practice (80 min) Total

Minutes

Ex:

170 min

Week # 1

(Please Circle)

Met/ Not Met

___________

(HRT initials) M P.E. 75

T

W P.E. 75

Th

F P.E. 75

Week # 2

(Please Circle)

Met/ Not Met

___________

(HRT initials) M

T P.E. 75

W

Th P.E. 75

F

Week # 3

(Please Circle)

Met/ Not Met

___________

(HRT initials) M P.E. 75

T

W P.E. 75

Th

F P.E. 75

Week # 4

(Please Circle)

Met/ Not Met

___________

(HRT initials) M

T P.E. 75

W

Th P.E. 75

F

Week # 5

(Please Circle)

Met/ Not Met

___________

(HRT initials) M P.E. 75

T

W P.E. 75

Th

F P.E. 75

The student has MET/ NOT MET the DPA requirements for the above month.

HR Teacher Signature: _____________________________

NAME: ___Bishr____________________________ HR: _____

Month:

May

List all physical activities participated in during the day.

Remember that students need to participate in a minimum of 30 minutes per day. Each activity must last at least 10 minutes.

Example: Dance class (70 min), walked at lunch (20 min), Soccer practice (80 min) Total

Minutes

Ex:

170 min

Week # 1

(Please Circle)

Met/ Not Met

___________

(HRT initials) M P.E. 75

T

W P.E. 75

Th

F P.E. 75

Week # 2

(Please Circle)

Met/ Not Met

___________

(HRT initials) M

T P.E. 75

W

Th P.E. 75

F

Week # 3

(Please Circle)

Met/ Not Met

___________

(HRT initials) M P.E. 75

T

W P.E. 75

Th

F P.E. 75

Week # 4

(Please Circle)

Met/ Not Met

___________

(HRT initials) M

T P.E. 75

W

Th P.E. 75

F

Week # 5

(Please Circle)

Met/ Not Met

___________

(HRT initials) M P.E. 75

T

W P.E. 75

Th

F P.E. 75

The student has MET/ NOT MET the DPA requirements for the above month.

HR Teacher Signature: _____________________________

NAME: ___Bishr____________________________ HR: _____

Month:

June

List all physical activities participated in during the day.

Remember that students need to participate in a minimum of 30 minutes per day. Each activity must last at least 10 minutes.

Example: Dance class (70 min), walked at lunch (20 min), Soccer practice (80 min) Total

Minutes

Ex:

170 min

Week # 1

(Please Circle)

Met/ Not Met

___________

(HRT initials) M P.E. 75

T

W P.E. 75

Th

F P.E. 75

Week # 2

(Please Circle)

Met/ Not Met

___________

(HRT initials) M

T P.E. 75

W

Th P.E. 75

F

Week # 3

(Please Circle)

Met/ Not Met

___________

(HRT initials) M P.E. 75

T

W P.E. 75

Th

F P.E. 75

Week # 4

(Please Circle)

Met/ Not Met

___________

(HRT initials) M

T P.E. 75

W

Th P.E. 75

F

Week # 5

(Please Circle)

Met/ Not Met

___________

(HRT initials) M P.E. 75

T

W P.E. 75

Th

F P.E. 75

The student has MET/ NOT MET the DPA requirements for the above month.

HR Teacher Signature: _____________________________