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FORM 3

Medical Certificate

2023 PHILIPPINE ROTC GAMES

SCHOOL

CITY

SPORTS

EVENT

MEDICAL CERTIFICAT
E
Branch of Service: ______________________
(Date)

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 to participate in the ROTC Games at the time of the examination.

Event:

Physical Examination

Date examined:
Height: Weight: Blood Pressure:
Pulse, Resting: Respiratory Rate:
Other

Physician/Medical Officer
(Signature over printed name)
License No.
PTR
License Expiry Date:

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