Republic of the Philippines

DEPARTMENT OF EDUCATION
___________x__________
(Region)
____MISAMIS ORIENTAL____
(Division)
JASAAN CENTRAL SCHOOL
(School)
JASAAN, MISAMIS ORIENTAL
(School Address)

MEDICAL CERTIFICATE

__________________
(Date)

To Whom It May Concern:

This is to certify that I have personally examined ____________________________ age

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

during the time of examination, to join and compete in the 2023 Division Festival of Talents.

Event: Philippine Folk Dancing

Physical Examination

Date examined: _______________

Height Weight: Blood Pressure
Pulse, Resting Respiratory Rate
Other Remarks:

Other findings Ye No If yes pls. Specify

s
Asthma
Food Allergy
Undergone
Operation
Kidney Infection
Heart Ailment
Other
____________________________
Physician/Medical Officer
(Signature over printed name)

License No. __________________

PTR.: ____________________
Date: ____________________

FOR PALARONG PAMBANSA ONLY

2023 Division Festival of Talents