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Medical Certificate For Coaches Asst. Coaches Chaperons 2

fgjuse hearyawnrstjs eh4he arrgerg

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Vince Bulayog
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19 views1 page

Medical Certificate For Coaches Asst. Coaches Chaperons 2

fgjuse hearyawnrstjs eh4he arrgerg

Uploaded by

Vince Bulayog
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Revised as of April 3, 2023 Republic of the Philippines

Department of Education
III – CENTRAL LUZON
(Region)
NUEVA ECIJA
(Division)
NAMPICUAN CHRISTIAN ACADEMY, INC.
(School)
WEST POBLACION, NAMPICUAN, N.E.

MEDICAL CERTIFICATE
(COACHES, ASSISTANT COACHES, CHAPERONE)

_______________________________
(Date)
To Whom It May Concern:

This is to certify that I have personally examined ____________________________ age ______ sex _____
Name
and have found that he/she is physically fit unfit, during the time of examination, to join and participate in

the lower meets up to Palarong Pambansa.

Event: ___________________________
Physical Examination
School/Intrams/District Meet Remarks/Findings:

________________________________________ Ht ._______cm Wt:_______kg FIT


Physician/Medical Officer
BP.____________mmHg
UNFIT
(signature over printed name) PR:____________bpm
PRC Date:
RR:____________cpm
LICENSE: PTR NO.
Unit/Division Meet Remarks/Findings:
Ht ._______cm Wt:_______kg
________________________________________ FIT
BP.____________mmHg
Physician/Medical Officer
PR:____________bpm UNFIT
(signature over printed name)
PRC RR:____________cpm Date:
LICENSE: PTR NO.
Regional Meet Remarks/Findings:
Ht ._______cm Wt:_______kg
________________________________________ FIT
BP.____________mmHg
Physician/Medical Officer
(signature over printed name) PR:____________bpm UNFIT
PRC RR:____________cpm
LICENSE: PTR NO. Date:
Palarong Pambansa Remarks/Findings:

________________________________________ Ht ._______cm Wt:_______kg FIT


Physician/Medical Officer
BP.____________mmHg
(signature over printed name) UNFIT
PRC PR:____________bpm
LICENSE: PTR NO. RR:____________cpm Date:

Note:
PLEASE USE A4 SIZE COPY PAPER
FOR SCHOOL SPORTS (Lower Meet up to PALARONG PAMBANSA)

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