Fun 2B Fit Data Sheet
*This form is to be completed by parents.
Camper Name
First Name
Last Name
Camper DOB
-
Month
-
Day
Year
Date
Parent / Guardian Name
First Name
Last Name
Date
-
Month
-
Day
Year
Date
Please indicate which number corresponds most accurately to your son / daughter after each statement. Be sure to answer each question.: My child is physically active in the summer/spring.
Always
Almost Always
Occasionally
Rarely
Never
My child is physically active in the summer/spring.
My child becomes short of breath when doing physical activities.
My child enjoys playing with other children.
My child plays video/computer games.
My child is physically active in the fall.
My child worries about being teased.
My child enjoys participating baseball / softball.
My child watches T.V.
My child is physically active in the winter.
My child avoids other children.
May child enjoys basketball.
My child enjoys soccer.
My child complains when s/he has to do something active.
My child is a “couch potato” in the winter.
My child makes good food choices on his/her own.
Our family cooks dinner together.
My child eats breakfast in the morning.
My child eats second helpings at meals.
My child avoids veggies.
My child eats “junk-food” after school.
Our family eats dinner together.
My child is a picky eater.
My child takes a packed lunch from home to school.
My child understands the nutritional value/consequence of food.
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