Printable Version

Family Fitness Program Instructions

On the family point count sheet (Form T1) print the starting month, second, third, and fourth months (if starting the program on any other day than the first of the month), along with the family member's names in each month's column. Record the points on the calendar day for each family member. At the end of each month, record each family member's total points for the month. At the end of the three month period, add up each of the family member's totals and record the family total in the lower right hand corner of the record form and circle the Family Medal qualified for.

Point count per family member (Parents, Grandparents, Guardians or other Adult Relatives will get double points):

Mile Walk/Jog/Run

Bike Ride

Points to be recorded by day for each participating family member (again, parents, grandparents or guardians, or other adult family relatives will get double points). Use another point count sheet if more than seven (7) family members participate. A parent or guardian must sign the final point count totals.

Number of family members from age five (5) and up: __________

Number of points needed to qualify for (based on a 3 month program):
number of
Family Members
Bronze Family Award30 points x___________ = ________ points
Silver Family Award60 points x___________ = ________ points
Gold Family Award90 points x___________ = ________ points
Platinum Family Award120 points x___________ = ________ points
Platinum Plus Family Award150 points x___________ = ________ points

After completion, sign, date, and keep a copy of the family point count sheet (Form T1) for your records. Please take or mail the family point count sheet (Form T1) to ______________________________________________________(TBA). Expect to receive your "Family Get Fit" certificate within three weeks by mail.

This program is made possible by the following sponsors:

Form T2