Republic of the Philippines

DEPARTMENT OF EDUCATION
Region XI
Division of Davao del Norte
MAGWAWA INTEGRATED SCHOOL
Brgy. Magwawa, Sto. Tomas Davao del Norte

M E D I C A L C E R T I F I C A T E

________________
(Date)

To Whom It May Concern:

This is to certify that I have personally examined ________________________________

age _________ sex _________ born on _______________________ and I have found that
he/she is physically fit, during the time of examination, to join and compete in the lower meets
and Palarong Pambansa.

Event: _____________________

Physical Examination

Date examined: _______________________

Height: ________________ Weight _______________ Blood Pressure _____________________
Pulse, Resting _____________________________ Respiratory Rate _____________________
Other Remarks _________________________________________________________________
_________________________________________________________________
_________________________________________________________________

______________________________
Physician / Medical Officer
(Signature over Printed Name)

License No. ____________________________

PTR: ____________________________
Date: ____________________________

FOR PALARONG BANSA ONLY