HEADQUARTERS

UNIVERSITY OF SAINT ANTHONY

DEPARTMENT OF MILITARY SCIENCE AND TACTICS
502nd (CAS) CDC, 5RCDG, ARESCOM
San Miguel, City of Iriga

CADET OFFICER APPLICATION

MEDICAL CERTIFICATE FORM

NAME:

ADDRESS:

AGE:

HEIGHT:
__________ in kgs.
WEIGHT:
__________ in cm.

SEX:
MALE FEMALE

BMI:
UNDERWEIGHT OBESE I
_______
NORMAL OBESE II

OVERWEIGHT

I hereby certify that I personally examined the above-named applicant and find no
medical condition or physical impairment that precludes his/her participation in the said
organization. He/She is in good condition and physically fit to undergo such training.

DATE EXAMINED NAME AND SIGNATURE OF EXAMINER LICENCE NO

NAME OF HOSPITAL/CLINIC

CONTACT NO.