DEPARTMENT OF EDUCATION

REGION IX, ZAMBOANGA PENINSULA

ZAMBOANGA CITY
CULIANAN NATIONAL HIGH SCHOOL
Culianan, Zamboanga City

MEDICAL CERTIFICATE

To Whom It May Concern:

This is to certify that I have personally examined _____________________________

age ______ sex _______ born on _______________ and have found that he/she is
physically fit, during the time of examination, to join and compete in the Lower
Meets and Palarong Pambansa.

Event: ______________________

Date examined: ________________________

Height: __________________ Weight: _____________ Blood Pressure: ___________________
Pulse, Resting ________________________ Respiratory Rate: _________________
Other Remarks:
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________

JUVIE B. TORIBIO
School Nurse

License No: ______________

PTR: _____________________
Date: ______________________