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Ste - Health Declaration Form

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Ronnel D. de Jesus
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108 views

Ste - Health Declaration Form

Uploaded by

Ronnel D. de Jesus
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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HEALTH DECLARATION FORM

Grade 7 Applicants for Science, Technology, and Engineering


(STE)/Legislated Science High School (LSHS)/Regional Science High School
(RSHS)

I am hereby device the health


Name of Parent/Legal Guardian

condition of my son/daughter
Name of student applicant

who is in good health and fit to undergo a rigorous academic program.

Please check ( ) the condition/s that applies/apply your son/daughter


that should be taken into consideration:

Health/physiological concerns:
visual impairment surgery
asthma
(specify) (specify)
Hearing impairment Other:
bronchitis
(specify) (specify)
Allergy
Speech delay none
(specify)

I hereby certify that the information supplied in this application is complete


and accurate.

Signature over Printed Name of Parent/Legal Guardian


Date Signed:
Contact Number:

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