Republic of the Philippines

DEPARTMENT OF EDUCATION
____________1____________
(Region)
PANGASINAN II
(Division)
GUILING-COLILING NATIONA HIGH SCHOOL
(School)
ROSALES, PANGASINAN
(School Address)

M E D I CAL C E R T I FI CAT E

_________________
(Date)

To Whom It May Concern:

This is to certify that I have personally examined PRIETO, MARY ANN J. age 45
Name

sex FEMALE born on NOVEMBER 08, 1972 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: SEPAKTAKRAW BOYS SECONDARY (COACH)

Physical Examination

Date examined: _________________

Height Weight: Blood Pressure
Pulse, Resting Respiratory Rate
Other Remarks:

____________________________
Physician/Medical Officer
(Signature over printed name)

License No. __________________

PTR.: ____________________
Date: ____________________

FOR PALARONG PAMBANSA ONLY

 Republic of the Philippines
DEPARTMENT OF EDUCATION
____________1____________
(Region)
PANGASINAN II
(Division)
GUILING-COLILING NATIONA HIGH SCHOOL
(School)
ROSALES, PANGASINAN
(School Address)

M E D I CAL C E R T I FI CAT E

_________________
(Date)

To Whom It May Concern:

This is to certify that I have personally examined LOPEZ, MARLON P.. age 44 sex
Name

MALE born on DECEMBER 04, 1973 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: SEPAKTAKRAW BOYS SECONDARY (ASSISTANT COACH)

Physical Examination

Date examined: _________________

Height Weight: Blood Pressure
Pulse, Resting Respiratory Rate
Other Remarks:

____________________________
Physician/Medical Officer
(Signature over printed name)

License No. __________________

PTR.: ____________________
Date: ____________________

FOR PALARONG PAMBANSA ONLY

 Republic of the Philippines
DEPARTMENT OF EDUCATION
____________1____________
(Region)
PANGASINAN II
(Division)
GUILING-COLILING NATIONA HIGH SCHOOL
(School)
ROSALES, PANGASINAN
(School Address)

M E D I CAL C E R T I FI CAT E

_________________
(Date)

To Whom It May Concern:

This is to certify that I have personally examined HALOC, CRESELDA M... age 53
Name

sex FEMALE born on APRIL 27, 1963 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: SEPAKTAKRAW GIRLS SECONDARY (COACH)

Physical Examination

Date examined: _________________

Height Weight: Blood Pressure
Pulse, Resting Respiratory Rate
Other Remarks:

____________________________
Physician/Medical Officer
(Signature over printed name)

License No. __________________

PTR.: ____________________
Date: ____________________

FOR PALARONG PAMBANSA ONLY