FORM 3

Medical Certificate

2023 PHILIPPINE ROTC GAMES

SCHOO

L CITY

SPORTS

EVENT

MEDICALCERTIFICA
TE
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 Rate: Respiratory Rate: Other

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