Republic of the Philippines

Department of Education
I
(Region)
Pangasinan Division II
(Division)
SAN MACARIO SUR ELEMENTARY SCHOOL
(School)
San Macario Natividad Pangasinan
School Address
Date:_____________________

MEDICAL CERTIFICATE
To Whom It May Concern:

This is to certify that I have personally examined ORDINARIO, JULIBER S.

age 40 sex MALE born on OCTOBER 2, 1975 and have found that
he/she is physically fit, during the time of examination, to coach in the lower meets and
Palarong Pambansa.

Event: WRESTLING SECONDARY GIRLS (COACH)

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:
 Republic of the Philippines
Department of Education
I
(Region)
Pangasinan Division II
(Division)
CABILAOAN AGRO-INDUSTRIAL HIGH SCHOOL
(School)
Cabilaoan Laoac Pangasinan
School Address
Date:_____________________

MEDICAL CERTIFICATE
To Whom It May Concern:

This is to certify that I have personally examined ANDAYAN CARMI VALEN P.

age 28 sex FEMALE born on AUGUST 9, 1986 and have found
that he/she is physically fit, during the time of examination, to act as chaperon in
the lower meets and Palarong Pambansa.

Event: WRESTLING SECONDARY GIRLS (CHAPERON)

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:
 Republic of the Philippines
Department of Education
I
(Region)
Pangasinan Division II
(Division)
JUAN G. MACARAEG NATIONAL HIGH SCHOOL
(School)
Canarvacanan Binalonan Pangasinan
School Address
Date:_____________________

MEDICAL CERTIFICATE
To Whom It May Concern:

This is to certify that I have personally examined FRANCISCO, JUMELYN E.

age 16 sex FEMALE born on APRIL 13, 1999 and 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: WRESTLING SECONDARY GIRLS

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:
 Republic of the Philippines
Department of Education
I
(Region)
Pangasinan Division II
(Division)
ROSALES NATIONAL HIGH SCHOOL
(School)
Don Antonio Village Rosales, Pangasinan
School Address
Date:_____________________

MEDICAL CERTIFICATE
To Whom It May Concern:

This is to certify that I have personally examined DE GUZMAN, SHANEYA MAE G.

age 15 sex FEMALE born on OCTOBER 6, 2000 and 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: WRESTLING SECONDARY GIRLS

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:
 Republic of the Philippines
Department of Education
I
(Region)
Pangasinan Division II
(Division)
NATIVIDAD ORIENTAL ACADEMY
(School)
Pob. West Natividad Pangasinan
School Address
Date:_____________________

MEDICAL CERTIFICATE
To Whom It May Concern:

This is to certify that I have personally examined ABANES, VIANNEY MAE RICA B.
age 15 sex FEMALE born on MAY 18, 2000 and 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: WRESTLING SECONDARY GIRLS

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:
 Republic of the Philippines
Department of Education
I
(Region)
Pangasinan Division II
(Division)
NATIVIDAD NATIONAL HIGH SCHOOL
(School)
Pob. East Natividad Pangasinan
School Address
Date:_____________________

MEDICAL CERTIFICATE
To Whom It May Concern:

This is to certify that I have personally examined NOVEDA, ELLOIZA MAE T.

age 16 sex FEMALE born on OCTOBER 24, 1999 and have found that
that he/she is physically fit, during the time of examination, to join and compete in the lower
meets and Palarong Pambansa.

Event: WRESTLING SECONDARY GIRLS

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:
 Republic of the Philippines
Department of Education
I
(Region)
Pangasinan Division II
(Division)
ROSALES NATIONAL HIGH SCHOOL
(School)
Don Antonio Village Rosales, Pangasinan
School Address
Date:_____________________

MEDICAL CERTIFICATE
To Whom It May Concern:

This is to certify that I have personally examined VILLAREAL, GRACE ANN M.

age 15 sex FEMALE born on FEBRUARY 28, 2000 and 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: WRESTLING SECONDARY GIRLS

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:
 53 MARI Republic of the Philippines
Department of Education
I
(Region)
Pangasinan Division II
(Division)
NATIVIDAD ORIENTAL ACADEMY
(School)
Pob. West Natividad Pangasinan
School Address
Date: any day before division meet

MEDICAL CERTIFICATE
To Whom It May Concern:

This is to certify that I have personally examined MARI, JHUNGIE F.

age 15 sex MALE born on OCTOBER 23, 2000 and 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: WRESTLING SECONDARY BOYS

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: