/ PalosVerdesPeninsula Unified School District
Physical Education/Private Instruction
Activity Log / 6, 7 & 8

Activity Log for Trimester123

Student’s Name ______Grade ____School ______

The activity log format must be maintained for this student each trimester, along with a record that documents progress toward the six required PE components. Days when the student is absent from school will not count toward the total minutes needed each week. Log must be presented to the school prior to the conclusion of each grading period.

According to the contract, you, as the approved instructor, must notify the school immediately

1. If there are any changes in time and/or days of instruction

2. If there are any changes in addresses or telephone number

3. If the student does not exceed 400 minutes of instruction every two weeks.

4. If the student becomes injured or is otherwise unable to complete the approved contract.

This is a sample activity log for one week:

Week/
Standard / Monday / Tuesday / Wednesday / Thursday / Friday
3
# Hours /
Standards
Addressed / Cardio Training
2 . / 3, 4, 5 . / Off / Skills Practice
3 . / 1, 2, 5 . / Off / Individual
Event
2.5 . / 2, 4, 5 .

Please verify the Activity Log, sign your name below and return it to school by____ /____ / ____

Students will receive a “Fail” grade if this form is not returned prior to the day indicated above.

Student Signature ______

Parent Signature ______

Instructor Signature ______
------SCHOOL USE ONLY------

Grade:PassFail

Comments:

______

______

Teacher Signature:______Date: ____ /____ / ____

Week

/ MONDAY / TUESDAY / WEDNESDAY / THURSDAY / FRIDAY
1
Hrs/Stn / ____./ ______/ ____./ ______/ ____./ ______/ ____./ ______/ ____./ ______
2
Hrs/Stn / ____./ ______/ ____./ ______/ ____./ ______/ ____./ ______/ ____./ ______
3
Hrs/Stn / ____./ ______/ ____./ ______/ ____./ ______/ ____./ ______/ ____./ ______
4
Hrs/Stn / ____./ ______/ ____./ ______/ ____./ ______/ ____./ ______/ ____./ ______
5
Hrs/Stn / ____./ ______/ ____./ ______/ ____./ ______/ ____./ ______/ ____./ ______
6
Hrs/Stn / ____./ ______/ ____./ ______/ ____./ ______/ ____./ ______/ ____./ ______
7
Hrs/Stn / ____./ ______/ ____./ ______/ ____./ ______/ ____./ ______/ ____./ ______
8
Hrs/Stn / ____./ ______/ ____./ ______/ ____./ ______/ ____./ ______/ ____./ ______
9
Hrs/Stn / ____./ ______/ ____./ ______/ ____./ ______/ ____./ ______/ ____./ ______
10
Hrs/Stn / ____./ ______/ ____./ ______/ ____./ ______/ ____./ ______/ ____./ ______
11
Hrs/Stn / ____./ ______/ ____./ ______/ ____./ ______/ ____./ ______/ ____./ ______
12
Hrs/Stn / ____./ ______/ ____./ ______/ ____./ ______/ ____./ ______/ ____./ ______
13
Hrs/Stn / ____./ ______/ ____./ ______/ ____./ ______/ ____./ ______/ ____./ ______
14
Hrs/Stn / ____./ ______/ ____./ ______/ ____./ ______/ ____./ ______/ ____./ ______

Activity Log – Grades 6, 7 and 8Page 1 of 2