Republic of the Philippines

Department of Education
Region III
Division of Mabalacat City
DOÑA ASUNCION LEE INTEGRATED SCHOOL

PHYSICAL FITNESS TEST SCORE CARD

NAME: GARCIA, AGATHA MIONETTH T. SEX: FEMALE AGE:12

SECTION: M. H. DEL PILAR

Part 1: Health-Related Fitness Test

A. BODY COMPOSITION: Body Mass Index (BMI)

1. Body Mass Index (BMI)

Height (meters) Weight (Kilograms) BMI Classification
1.55 m 65 kls 27.08 Overweight

B. CARDIOVASCULAR ENDURANCE: 3-Minute Step

Heart Rate per minute
Before the Activity After the Activity
42 54

C. STRENGTH

1. Push up 2. Basic Plank

Number of Push ups Time
20 42 seconds

D. FLEXIBILITY

1. Zipper Test 2. Sit and Reach

Overlap/Gap (centimeters) Score (centimeters)
Right Left First Try Second Try Best Score
Fingers Fingers 42 cm 43 cm 43 cm
overlapped by 2.3 overlapped by 1
cm cm

Address: Xevera, Tabun, Mabalacat City, Pampanga

Email Address: dalis@depedmabalacat.org
Part 2: Skill-Related Fitness Test

A. COORDINATION: Juggling Score:

B. AGILITY: Hexagon Agility Test

Clockwise: Time (00:00) Counterclockwise: Time Average
(00:00)
7 seconds 7 seconds 7 seconds

C. SPEED: 40 meter sprint Time:

D. POWER: Standing Long Jump

Distance (centimeters)
First Trial Second
Trial

E. BALANCE: Stork Balance Stand Test

Right Foot: Time Left Foot: Time (00:00)
(00:00)
1 minute 22 seconds 2 minutes 22 seconds

F. REACTION TIME: Stick Drop Test

1st Trial 2nd Trial 3rd Trial Middle
Score
19 cm 15cm 16cm 16cm

LARRY S. SIMBULAN
P.E Teacher

Address: Xevera, Tabun, Mabalacat City, Pampanga

Email Address: dalis@depedmabalacat.org