GREEN POINT ACADEMY

G.T. Road, Kulti (Kultora), P.O. – Sitarampur, Dist. - Paschim Bardhaman,

West Bengal, PIN: 713359, India
Affiliated to C.B.S.E, Delhi up to +2 Level

Affiliation No. – 243011 School Code: 15619

Health and Activity

Record

General Information

Aadhaar Card No. of Student (Optional) _______________________________________________

Name: _________________

Admission No: Date of Birth:

Male/ Female/ Transgender:__________________________Blood Group:

Mother’s Name:
Y.O.B Weight Height Blood Group

Aadhaar Card No. (Optional)

Father’s Name:

Y.O.B Weight Height Blood Group

Family Monthly Income ________________________

Aadhaar Card No. (Optional) ___________________________ ________

Address

Phone No______________________________ Mobile No

CWSN Specify _____________________________________

Date: ………………………………… Signature of Parents/Guardian

 HEALTH AND ACTIVITY
Fitness Fitness RECORD
Parameters Test Name What does it Measure Record
Components

Health Body BMI Body Mass Index for

Components Composition Specific Age and Gender

Core Partial Curl Abdominal Muscular

up Endurance
Muscular Strength
Upper Body Flexed/Bent Arm Hang Muscular Endurance /
Functional Strength
Flexibility Sit and Reach Measures the flexibility of
the Lower Back and
hamstring Muscles

Endurance 600 Meters Run Cardiovascular Fitness/

Cardiovascular Endurance

Balance Static Balance Flamingo Balance Test Ability to Balance

Successfully on Single leg

Skill Agility Shuttle Run Test of Speed and Agility

Components
Speed Sprint/ Dash Determines Acceleration
and Speed
Power Standing Vertical Jump Measures the leg Muscle
Power
Coordination Plate Tapping Tests Speed and
Coordination of limb
Alternative Hand Wall Measures hand-eye
Toss Test coordination
 HEALTH AND ACTIVITY
RECORD
Components Parameters Record
Vision RE/LE
Ears Left/ Right
Teeth Occlusion Caries/ Tonsils/ Gums
General Body Measurements Height
Weight
Circumferences Hip
Waist
Health Status Pulse
Blood Pressure
Posture Evaluation If any:
Head Forward/ Sunken Chest/ Round Shoulders/ Kyphosis/ Lordosis/
Abdominal Ptosis/ Body Lean/ Tilted Head/ Shoulders Uneven/ Scoliosis/ Flat
Feet/ Knock Knees/ Bow Legs
Sporting Activities (HPE) Strand 1 :
Any one of the following:
1. Athletic / Swimming
2. Team Game
3. Individual Games
4. Adventure Sports
Strand 2 :
Health and Fitness
(Mass PT, Yoga, Dance, Calisthenics, Jogging, Cross Country Run, Working out
using weights/ gym equipment, Tai-Chi etc.)

Strand 3:
SEWA
 Website: greenpointacademy.org Phone: 03412514399/2014643
Email: greenpointacademy@gmail.com

GREEN POINT ACADEMY

G.T. Road, Kulti (Kultora), P.O. – Sitarampur, Dist. – Paschim Bardhaman,
West Bengal, PIN: 713359, India
Affiliated to C.B.S.E, Delhi upto +2 Level
Affiliation No. - 2430111 School Code: 15619

Name:- , Class:- , Section:- , Roll No:-

Admission No.:- , Gender:-

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A CERTIFICATE OF VISION AND EARS

1. Right Eye/ Left Eye :-

Right Ear/ Left Ear: -

Doctor Name & Signature (With Stamp) :-

Redg. No.:-

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A CERTIFICATE OF TEETH OCCLUSION

1. Carries:-

2. Tonsils:-

3. Gums:-

Doctor Name & Signature (With Stamp) :-

Redg. No.:-

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A CERTIFICATE OF BP, PULSE & POSTURE EVALUATION

1. Blood Pressure:-

2. Pulse:

3. Posture Evaluation:-

Doctor Name & Signature (With Stamp):-

Redg. No.:-