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    Medical For Coaches Asst Coaches Chaperones 1

    Uploaded by

    Noreen Demain
    This medical certificate certifies that a student is physically fit or unfit to participate in sporting events from school intramurals up to the Palarong Pambansa national games. It provides spaces to record the student's height, weight, blood pressure, pulse rate, and respiratory rate at different levels of competition. The examining physician signs with their professional license information to verify the student's fitness level.

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    © All Rights Reserved
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    Medical For Coaches Asst Coaches Chaperones 1

    Uploaded by

    Noreen Demain
    79 views1 page
    This medical certificate certifies that a student is physically fit or unfit to participate in sporting events from school intramurals up to the Palarong Pambansa national games. It provides spaces to record the student's height, weight, blood pressure, pulse rate, and respiratory rate at different levels of competition. The examining physician signs with their professional license information to verify the student's fitness level.

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    Medical-for-Coaches-Asst-Coaches-Chaperones-1

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    This medical certificate certifies that a student is physically fit or unfit to participate in sporting events from school intramurals up to the Palarong Pambansa national games. It provides spaces to record the student's height, weight, blood pressure, pulse rate, and respiratory rate at different levels of competition. The examining physician signs with their professional license information to verify the student's fitness level.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    79 views1 page

    Medical For Coaches Asst Coaches Chaperones 1

    Uploaded by

    Noreen Demain
    This medical certificate certifies that a student is physically fit or unfit to participate in sporting events from school intramurals up to the Palarong Pambansa national games. It provides spaces to record the student's height, weight, blood pressure, pulse rate, and respiratory rate at different levels of competition. The examining physician signs with their professional license information to verify the student's fitness level.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
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    Revised as of September 26, 2019

    Republic of the Philippines MCForm - 3


    DEPARTMENT OF EDUCATION
    _______CARAGA REGION______
    (Region)
    _____Bislig City___
    (Division)
    __New Jerusalem Elementary School__
    (School)
    ___Km. 20, San Jose, Bislig City, Surigao del Sur__
    (School Address)

    MEDICAL CERTIFICATE
    (COACHES, ASSISTANT COACHES, CHAPERONE)

    __________________
    (Date)
    To Whom It May Concern:

    This is to certify that I have personally examined ___________________________


    Name
    age __ sex _______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.

    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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