The Global Matrix 3.0 “Report Card” assessment of physical activity was developed to achieve a better understanding of the global variability in child and youth physical activity. Lithuania joined the Global Matrix 3.0. The aim of this article is to summarize the results of the first Lithuanian Report Card, which included 10 indicators, as representative of individual behaviors, sources, and settings of influence indicators, and a health-related characteristic. The grades for each indicator were based on the best available Lithuanian data. The findings showed poor Overall Physical Activity, Active Transportation (C−), and Family and Peers (D). Sedentary behavior was graded C−, and Organized Sport Participation, Community and Environment, and Government were graded C. Physical Fitness and School indicators received the highest grade (C+). The first Lithuanian Report Card on Physical Activity of Children and Youth shows that Lithuanian children and youth have less than satisfactory levels of organized physical activity, active transportation to and from school, community and built environments, and government strategies and investments. The low levels of support from family and peers require more attention from health promoters. There is a gap in the evidence about active play that should be addressed by researchers and policy makers.