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Palaro 2009 Medical Certificate

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TFSS Form No 002 MC

Republic of the Philippines


Department of Education
______________________
(Region)
______________________
(Division)

MEDICAL CERTIFICATE

__________________
(Date)

To Whom It May Concern:

This is to certify that I have personally examined ____________________________


Name
age ______ sex _____ born on ______________________ and have found that he/she is fit

to join and compete in the Palarong Pambansa Program.

I further certify that he/she is within the age requirement.

Event: ___________________________

Physical Examination

Height Weight: Blood Pressure


Pulse, Resting Respiratory Rate
Other Remarks:

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

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