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$10,000 Contest Testing Data Form

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Name Address

f%T\y

Start Date

7b/? JS /?/^ ?tW

Gender

(7/n ah a

Up

bp) 13 b

Phone#

KEMh a tsrn CL omcuL Q2n

Email

ioh --------- nw □ Female

Male

Age

________________

10 Week Location

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10 K Location

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Note: Testing 1 will be 10 to 12 weeks following^the finishing of the first 10 week program. Testing 4 will be 1 year from finishing the first 10 weeks.

10 Week

Initial

Picture taken

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ZA.Mf-

Push-Ups

3%

EfNo

Sit-Ups Sit and Reach Score lS[Mile Run

□ Walk Run

^ - It

Testing 4

1/

Weight in Pounds

Knees: □ Yes

Testing 3

j

scale#

Body Fat Percentage

Testing 2

ia/i'T/ii# 31 io| it If/l/lT

IfltylRt

Evaluation Date

Body Weight

Testing 1

3\ 1 '

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l
hip I'j'L

5?

5L\

2 | 1 (Do lux

11. r/

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if 11

tl ‘17 fm%/$>

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Location Manager Initials

Optional MEASUREMENTS: (use left side of body for arm and thigh) • • • • •

The chest should be measured at the largest point, arms down, measure in back. For waist, measure around the individual at the belly button. For arm, place right at left elbow, pinky finger parallel down, measure at the top of the hand, (index finger) For thigh, place left thumb in groin, measure below the pinky finger. Flips should be measured at the largest point, use hip flexor area as beginning placement point.

All measurements in inches:

Initial

Hips

Testing 2

Z- b .3 -1$

.73 ^ 2 3o

Testing 3

Testing 4

40 5

M"3

Arm Thigh

Testing 1

HI

Chest Waist

10 Week

3b .b'

Yoboi

_ -M___ www.extremebodyshaping.com

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