Name:
___________________

Period: _____________

3rd Quarter Homework Log

Students are to participate
in physical activity for a minimum of 30 minutes, two times per week.

For each week, include the
date, activity (what you did), duration (how long you did it) and
parent/guardian/coach’s signature. Activities may include team or
individual sports, such as football, basketball, etc., or leisure activities
such as walking or bike riding.

EXAMPLE:

Date 10/15  Activity   SWIMMING      Duration  30
MIN.  Signature Parent/Guardian

Week 1 Date _____ Activity  _____________  Duration_______  Signature__________

Date _____ Activity  _____________  Duration_______  Signature__________

Week 2 Date _____ Activity  _____________  Duration_______  Signature__________

Date _____ Activity  _____________  Duration_______  Signature__________

Week 3 Date _____ Activity  _____________  Duration_______  Signature__________

Date _____ Activity  _____________  Duration_______  Signature__________

Week 4 Date _____ Activity  _____________  Duration_______  Signature__________

Date _____ Activity  _____________  Duration_______  Signature__________

Week 5 Date _____ Activity  _____________  Duration_______  Signature__________

Date _____ Activity  _____________  Duration_______  Signature__________

Week 6 Date _____ Activity  _____________  Duration_______  Signature__________

Date _____ Activity  _____________  Duration_______  Signature__________

Week 7 Date _____ Activity  _____________  Duration_______  Signature__________

Date _____ Activity  _____________  Duration_______  Signature__________

Week 8 Date _____ Activity  _____________  Duration_______  Signature__________

Date _____ Activity  _____________  Duration_______  Signature__________

Week 9 Date _____ Activity  _____________  Duration_______  Signature__________

Date _____ Activity  _____________  Duration_______  Signature__________

Week 10 Date _____ Activity  _____________  Duration_______  Signature__________

Date _____ Activity  _____________  Duration_______  Signature__________