Enver Creek Secondary – Graduation Transitions (2015) – Personal Health Component (Student Form)
PERSONAL HEALTH COMPONENT
STUDENT FORMS

Grade 10 Year:
150 Minutes Per Week Of Physical Activity

Grade 11 Year:
150 Minutes Per Week Of Physical Activity

Grade 12 Year:
150 Minutes Per Week Of Physical Activity

Healthy Living Plan
Instructions/information (next page) …
Enver Creek Secondary – Graduation Transitions (2015) – Personal Health Component (Student Form)
Personal Health Component
Frequently Asked Questions
1. What are students to do with their completed documents for Personal Health?
Completed documents are submitted to a Graduation Transitions Coordinator for evaluation and recording.
Students are expected to place their forms in the clearly labeled GT slots in the Career Centre in room
133, unless work is being collected by a Planning 10 teacher (see information below).
•
150 Minutes Per Week of Physical Activity forms (Personal Health Component) are
collected from Grade 10 and 11 students in May. Grade 12 students submit this form on the
same day of their GT presentation.
•
Healthy Living Plan (Personal Health Component) is documented and evaluated in Planning
10. Students who do not submit this document in Planning 10 should submit immediately to
the Career Centre (room 133) for evaluation (file into appropriate GT slot).
Important: Students need to confirm that returned work has been completed satisfactorily by looking for a
GT Coordinator’s stamp of completion. If no completion stamp is present, revisions are required (carefully
complete and/or correct ALL sections). Promptly re-submit your work for marking.
Important: Students should keep their Graduation Transitions documents in a safe place to avoid
loss (this documentation will be used to prepare for the presentation in Grade 12).
2. How can students acquire physical activity time?
a) Students can participate in “in-school” physical activity (e.g. physical education class, dance class,
school athletics, intramurals, specials events or clubs).
Note: A one semester class or single event will only partially fulfill this requirement so students must be
physically active for an entire school year to complete this requirement.
b) Students can participate in “out-of-school” physical activity (see examples below)
HOUSEHOLD CHORES
• Washing floors, walls, bathtubs, cars
• Walking the dog
• Mowing the lawn, raking leaves
• Shoveling (gravel, top soil, mulch)
TRANSPORTATION
• Riding a bicycle to the store
• Walking to school, the library, the movies
• In-line skating to a friend’s house
RECREATION
• Swimming
• Hiking
• Skiing, snowboarding
• Canoeing, kayaking, paddle-boating
COMMUNITY ATHLETIC TEAMS /CLUBS,
FITNESS/DANCE CLASSES, ETC.
• Hockey, soccer, wrestling, figure skating
• Karate, Tai Kwon Do, Kick-boxing
• Aquacise, pilates, bhangra, ballet,
3. How do students document their 150 minutes per week of physical activity?
Students will be required to submit a 150 Minutes per Week of Physical Activity form (see below to obtain
form) signed by a parent/guardian to verify that this requirement has been met.
To obtain form go to www.surreyschools.ca/schools/envercreek. Scroll down to “Publications” click on “Grad
Transitions Information” scroll down click on “Personal Health Component” to locate form.
Enver Creek Secondary – Graduation Transitions (2015) – Personal Health Component (Student Form)
Graduation Transitions – Personal Health Component
GRADE 10 YEAR:
___________________________________
GT Coordinator’s stamp (above) confirms completion
150 MINUTES PER WEEK OF PHYSICAL ACTIVITY
Student Name: ________________________ Pupil #: ________ TAG: ____
(please print full name)
1. Please check the box(s) below to indicate how you completed your 150 minutes
per week of moderate to vigorous physical activity for Grade 10 (two semesters).

School: PE/Fitness class (check additional




School: Dance class
Team games (soccer, basketball, etc.)
Individual games (tennis, badminton, etc.)
Recreation (hiking, mt. biking, etc.)





box as this is for one semester only)
Transportation (walking, cycling, etc.)
Fitness (swimming, aerobics, etc.)
Dance
Weight training
Household chores (shoveling, etc.)
2. Moderate to vigorous physical activity is 60% to 80% of maximum heart rate.
Use the table below to find your target heart rate.
Use a checkmark below to indicate your age in Grade 10 (as of September 1st).
For Future Reference
Target Heart Rate
Age
60%
80%
 14 years old
 15 years old
 16 years old
 17 years old
124
165
123
164
122
163
122
162
Target Heart Rate Formula:
(220 – age) = x .6 = 60%
(220 – age) = x .8 = 80%
Make a habit of checking your heart rate
during exercise/activity to ensure it falls
within this range to qualify.
3.
To be completed by a parent or guardian only:
I hereby verify that the above named student has participated in 150 minutes of moderate to
vigorous physical activity per week during his/her Grade 10 year (incl. both semesters).
Parent/Guardian Printed Name:
Parent/Guardian Signature:
Date/Duration: From September 20
to May 20
Attention Student:
You must complete 150 minutes per week of moderate to vigorous physical activity in grade 10,
11, and 12. Therefore you must submit a copy of this form at the end of each school year.
___ Satisfactory

Revise & Re-submit
Page 1 of 1
Enver Creek Secondary – Graduation Transitions (2015) – Personal Health Component (Student Form
Graduation Transitions – Personal Health Component
GRADE 11 YEAR:
___________________________________
GT Coordinator’s stamp (above) confirms completion
150 MINUTES PER WEEK OF PHYSICAL ACTIVITY
Student Name: ________________________ Pupil #: ________ TAG: ____
(please print full name)
1. Please check the box(s) below to indicate how you completed your 150 minutes
per week of moderate to vigorous physical activity for Grade 11 (two semesters).











School: PE/Fitness class (1 semester only)
School: PE/Fitness class (2 semesters)
School: Dance class
Team games (soccer, basketball, etc.)
Individual games (tennis, badminton, etc.)
Recreation (hiking, mt. biking, etc.)
Transportation (walking, cycling, etc.)
Fitness (swimming, aerobics, etc.)
Dance
Weight training
Household chores (shoveling, etc.)
2. Moderate to vigorous physical activity is 60% to 80% of maximum heart rate.
Use the table below to find your target heart rate.
Use a checkmark below to indicate your age in Grade 11 (as of September 1st).
For Future Reference
Target Heart Rate
Age
60%
80%
 15 years old
 16 years old
 17 years old
 18 years old
123
164
122
163
122
162
121
162
Target Heart Rate Formula:
(220 – age) = x .6 = 60%
(220 – age) = x .8 = 80%
Make a habit of checking your heart rate
during exercise/activity to ensure it falls
within this range to qualify.
3.
To be completed by a parent or guardian only:
I hereby verify that the above named student has participated in 150 minutes of moderate to
vigorous physical activity per week during his/her Grade 11 year (incl. both semesters).
Parent/Guardian Printed Name:
Parent/Guardian Signature:
Date/Duration: From September 20
to May 20
Attention Student:
You must complete 150 minutes per week of moderate to vigorous physical activity in grade 10,
11, and 12. Therefore you must submit a copy of this form at the end of each school year.
___ Satisfactory

Revise & Re-submit
Page 1 of 1
Enver Creek Secondary – Graduation Transitions (2015) – Personal Health Component (Student Form)
Graduation Transitions – Personal Health Component
GRADE 12 YEAR:
___________________________________
GT Coordinator’s stamp (above) confirms completion
150 MINUTES PER WEEK OF PHYSICAL ACTIVITY
Student Name: ________________________ Pupil #: ________ TAG: ____
(please print full name)
1. Please check the box(s) below to indicate how you completed your 150 minutes
per week of moderate to vigorous physical activity for Grade 12 (two semesters).











School: PE/Fitness class (1 semester only)
School: PE/Fitness class (2 semesters)
School: Dance class
Team games (soccer, basketball, etc.)
Individual games (tennis, badminton, etc.)
Recreation (hiking, mt. biking, etc.)
Transportation (walking, cycling, etc.)
Fitness (swimming, aerobics, etc.)
Dance
Weight training
Household chores (shoveling, etc.)
2. Moderate to vigorous physical activity is 60% to 80% of maximum heart rate.
Use the table below to find your target heart rate.
Use a checkmark below to indicate your age in Grade 12 (as of September 1st).
For Future Reference
Target Heart Rate
Age
60%
80%
 15 years old
 16 years old
 17 years old
 18 years old
123
164
122
163
122
162
121
162
Target Heart Rate Formula:
(220 – age) = x .6 = 60%
(220 – age) = x .8 = 80%
Make a habit of checking your heart rate
during exercise/activity to ensure it falls
within this range to qualify.
3.
To be completed by a parent or guardian only:
I hereby verify that the above named student has participated in 150 minutes of moderate to
vigorous physical activity per week during his/her Grade 12 year (incl. both semesters).
Parent/Guardian Printed Name:
Parent/Guardian Signature:
Date/Duration: From September 20
to May 20
Attention Student:
You must complete 150 minutes per week of moderate to vigorous physical activity in grade 10,
11, and 12. Therefore you must submit a copy of this form at the end of each school year.
___ Satisfactory

Revise & Re-submit
Page 1 of 1
Enver Creek Secondary – Graduation Transitions (2015) – Personal Health Component (Student Form)
Graduation Transitions – Personal Health Component
HEALTHY LIVING PLAN
___________________________________
GT Coordinator’s stamp (above) confirms completion
Student Name: ___________________________ Pupil #: ________ TAG: ____
(please print full name)
The information that is checked-off and/or given below describes this student’s
current healthy living plan:
1. I practice sound nutritional habits by:













meeting the recommended servings as outlined in Canada’s Food Guide
eating breakfast
eating smaller portions more often throughout the day (e.g. three meals & two snacks)
choosing lower fat options (e.g. dairy products, condiments, prepared foods, snacks, etc.)
eating fresh and/or baked foods more often than fried or deep-fried foods
limiting foods high in salt & sugar
choosing to eat leaner meats and/or meat alternatives more often
including high fibre foods in my diet
limiting foods containing caffeine (e.g. coffee, tea, soft drinks, etc.)
eating fresh fruits more often than those that are prepared/processed
eating fresh vegetables more often than those that are prepared/processed
drinking at least one litre of water a day
other___________________________________________________________
2. I know that endurance, flexibility and strength contribute to a person’s overall
physical fitness: (check the box(es) below that apply to you)
 I include all 3 components in my 150 minutes of physical activity and/or
 I must improve in one or more of the following:
(If you checked this box you must also check at least 1 circle below)
o Endurance:
This component benefits the heart and lungs. Continuous activities minimum 20 minutes - that make you breath deeper, your heart beat faster and your
body sweat (e.g. jogging, swimming, dancing)
o Flexibility:
This component keeps joints mobile. Activities involving stretching,
reaching and bending (e.g. martial arts, yoga, volleyball)
o Strength:
This component builds muscles and bones and improves posture.
Activities that use muscles against some resistance (e.g. weight lifting, Pilates,
basketball and shoveling)
___ Satisfactory

Revise & Re-submit
Page 1 of 2
Enver Creek Secondary – Graduation Transitions (2015) – Personal Health Component (Student Form)
HEALTHY LIVING PLAN (continued…)
The information that is checked-off and/or given below describes this student’s
current healthy living plan:
3. I manage my emotional health in the following way(s):











I maintain a positive self-image and/or self-concept
I engage in relaxation activities (e.g. reading, listening to music, walking, etc.)
I socialize
I participate in recreational activities/hobbies for fun
I maintain/develop my spirituality
I have someone to confide in and/or someone who offers good advice
I use time management techniques/strategies to ensure my responsibilities are met
and/or to reduce stress in my life
I have positive relationships (e.g. family, friends, work, school, etc.)
I am aware of my personal values and my actions/decisions often reflect them
I demonstrate assertiveness when necessary
other:
4. I am making other positive health choices by:












getting adequate sleep (at least 8 hours on average)



using risk management strategies (e.g. wearing a helmet when cycling, etc.)
not smoking
not using/misusing drugs/alcohol
abstaining from sexual relationships or practicing safe sex
flossing and brushing my teeth regularly
scheduling physical check-ups when necessary
scheduling dental exams every six months
scheduling an eye examination once a year
protecting my skin from excessive sun exposure (e.g. wearing sunscreen, hat, etc.)
driving safely (e.g. following speed limits, using care and attention, etc.)
washing my hands regularly
using appropriate care in food preparation and storage (e.g. clean/disinfect surfaces,
proper cooking temperatures and refrigeration, etc.)
knowing and practicing safety policies and procedures in my workplace
other:
Page 2 of 2