Republic of the Philippines

Department of Education
REGION III – CENTRAL LUZON
SCHOOLS DIVISION OFFICE OF NUEVA ECIJA

MEDICAL CERTIFICATE
FOR EDUCATIONAL TOUR

DISTRICT: TALUGTUG
SCHOOL: CINENSE INTEGRATED SCHOOL
GRADE & SECTION: GRADE IV AGUINALDO
DATE:APRIL 7, 2024

THIS IS TO CERTIFY THAT THE FOLLOWING LEARNERS HAVE BEEN FOUND TO BE:

A. PHYSICALLY FIT TO TRAVEL

NAME
1. ANGEL KURT L. DAYAG
2. PRINCESS SARAH P. TODEÑO
3.
4.

B. PHYSICALLY FIT TO TRAVEL BUT WITH MEDICAL OR HEALTH RESERVATION (e.g. allergy, bronchial
asthma, fainting, dizziness during travel, heart problems, etc.)
NOTE: Learner with FEVER is discouraged from joining the tour.

NAME AILMENTS
1.
2.
3.
4
5.

THIS CERTIFICATION IS ISSUED FOR TRAVEL PURPOSES ONLY.

PREPARED by: AISIELYN S. GARCES

NOTED and VERIFIED by: (District Nurse)

APPROVED by: (Division Medical Officer)

Address: Brgy. Rizal, Santa Rosa, Nueva Ecija 3101

Telephone No.: (044) 940 3121
Email: nueva.ecija@deped.gov.ph
Facebook Page: DepEd SDO Nueva Ecija
Webpage: https://sites.google.com/deped.gov.ph/depednuevaecija/