REGISTRATION FORM

NAME - REGISTRATION NO-

AGE-
SEX-
CLASS AND SECTION-

GENERAL EXAMINATION
WEIGHT (kg)- HEIGHT (cm) - MID-ARM CIRCUMFERENCE-

VITAL SIGNS-
TEMPERATURE
PULSE-
RESPIRATION-
VISUAL ACUITY- /6

DENTAL CARIES- YES / NO

ANY OTHER ILLNESS -

REGISTRATION FORM

NAME - REGISTRATION NO-

AGE-
SEX-
CLASS AND SECTION-

GENERAL EXAMINATION
WEIGHT (kg)- HEIGHT (cm) - MID-ARM CIRCUMFERENCE-

VITAL SIGNS-
TEMPERATURE
PULSE-
RESPIRATION-
VISUAL ACUITY- /6

DENTAL CARIES- YES / NO

ANY OTHER ILLNESS-