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  • Medical For Coaches Asst Coaches Chaperones - v2023 A4 Blank

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    SHIERRA ANNE CARAEL
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    This medical certificate certifies that a student named [name redacted] was found physically fit after examination to participate in lower level athletic competitions including school, district, and regional meets leading up to the national Palarong Pambansa games. The physician conducted physical examinations at each level of competition, recording height, weight, blood pressure, pulse, and respiration findings. The student was deemed physically fit after each examination to continue competing.

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    This medical certificate certifies that a student named [name redacted] was found physically fit after examination to participate in lower level athletic competitions including school, district, and regional meets leading up to the national Palarong Pambansa games. The physician conducted physical examinations at each level of competition, recording height, weight, blood pressure, pulse, and respiration findings. The student was deemed physically fit after each examination to continue competing.

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    4 views1 page

    Medical For Coaches Asst Coaches Chaperones - v2023 A4 Blank

    Uploaded by

    SHIERRA ANNE CARAEL
    This medical certificate certifies that a student named [name redacted] was found physically fit after examination to participate in lower level athletic competitions including school, district, and regional meets leading up to the national Palarong Pambansa games. The physician conducted physical examinations at each level of competition, recording height, weight, blood pressure, pulse, and respiration findings. The student was deemed physically fit after each examination to continue competing.

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    Revised as of September 26, 2019 Republic of the Philippines MCForm - 3

    DEPARTMENT OF EDUCATION
    Region XI
    (Region)
    Davao City Division
    (Division)
    Xxxxxxx Xxxxxx Xxxxxx
    (School)
    Xxxxxx Xxxxx Xxxxxx
    (School Address)

    MEDICAL CERTIFICATE
    (COACHES, ASSISTANT COACHES, CHAPERONE)

    xxxx
    __________________
    (Date)
    To Whom It May Concern:
    xxxx
    This is to certify that I have personally examined __________________________
    Name
    xx sex _____
    age ______ x and have found that he/she is physically fit unfit,

    during the time of examination, to join and participate in the lower meets up to Palarong

    Pambansa.

    xxxx
    Event: ___________________________

    Physical Examination

    School/Intrams/District Meet Remarks/Findings:

    ________________________________________ Ht ._______cm Wt:_______kg FIT


    Physician/Medical Officer
    BP.____________mmHg
    (signature over printed name) UNFIT
    PRC PR:____________bpm
    LICENSE: PTR NO. Date:
    RR:____________cpm
    Unit/Division Meet Remarks/Findings:

    ________________________________________ Ht ._______cm Wt:_______kg FIT


    Physician/Medical Officer
    BP.____________mmHg
    (signature over printed name) UNFIT
    PRC PR:____________bpm
    LICENSE: PTR NO. Date:
    RR:____________cpm
    Regional Meet Remarks/Findings:

    ________________________________________ Ht ._______cm Wt:_______kg FIT


    Physician/Medical Officer
    BP.____________mmHg
    (signature over printed name) UNFIT
    PRC PR:____________bpm
    LICENSE: PTR NO. Date:
    RR:____________cpm
    Palarong Pambansa Remarks/Findings:

    ________________________________________ Ht ._______cm Wt:_______kg FIT


    Physician/Medical Officer
    BP.____________mmHg
    (signature over printed name) UNFIT
    PRC PR:____________bpm
    LICENSE: PTR NO. Date:
    RR:____________cpm

    FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)

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