NAME AND LAST NAME:    ________________________________________________________

 

DATE OF BIRTH:  _______/________/________    GRADE: __________

 

 

1. POINT OUT IF YOU ARE SUFFERING ANY OF THESE DESEASES:

 

                              ALLERGYS(¿WHICH ONES?)_______________________________________________________

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       - Asthma                 -Cardiopathy                -Overweight

 

      - Epilepsy                  -Diabetes            

 

       -Sight/hearing/motor diseases ______________________________________

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         -Others: __________________________________________________________________________________________________________________________________________________________________

 

2. DO YOU PRACTICE ANY SPORTS OR PHYSICAL ACTIVITY IN YOUR FREE TIME? ___________

 

3. WHAY KIND OF EXERCISE?

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4. HOW MANY DAYS DO YOU PRACTICE PER WEEK? DURATION?

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5. IN CASE THAT YOU DO NOT PRACTICE ANY PHYSICAL ACTIVITY, NAME WHICH ONES YOU WOULD LIKE TO PRACTICE.

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