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  • Medical For Coaches Asst Coaches Chaperones

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    Randy Baluyut
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    This medical certificate certifies that Randy O. Baluyut, age 37, was found physically fit after examination to participate in volleyball competitions from school intramurals up to the Palarong Pambansa national games. The physician recorded his height as 173 cm and weight as 60 kg, with normal blood pressure, pulse, and respiration. Physical examination results are left blank for higher level competitions, to be filled out if and when he advances. The certificate is issued by the physician to verify Randy Baluyut's physical eligibility for school sports.

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    Medical-for-Coaches-Asst-Coaches-Chaperones

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    This medical certificate certifies that Randy O. Baluyut, age 37, was found physically fit after examination to participate in volleyball competitions from school intramurals up to the Palarong Pambansa national games. The physician recorded his height as 173 cm and weight as 60 kg, with normal blood pressure, pulse, and respiration. Physical examination results are left blank for higher level competitions, to be filled out if and when he advances. The certificate is issued by the physician to verify Randy Baluyut's physical eligibility for school sports.

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    4 views1 page

    Medical For Coaches Asst Coaches Chaperones

    Uploaded by

    Randy Baluyut
    This medical certificate certifies that Randy O. Baluyut, age 37, was found physically fit after examination to participate in volleyball competitions from school intramurals up to the Palarong Pambansa national games. The physician recorded his height as 173 cm and weight as 60 kg, with normal blood pressure, pulse, and respiration. Physical examination results are left blank for higher level competitions, to be filled out if and when he advances. The certificate is issued by the physician to verify Randy Baluyut's physical eligibility for school sports.

    Copyright:

    © All Rights Reserved
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    Republic of the Philippines MCForm - 3

    DEPARTMENT OF EDUCATION
    III
    (Region)
    TARLAC PROVINCE
    (Division)
    SAN AGUSTIN ELEMENTARY SCHOOL
    (School)
    SAN AGUSTIN, CONCEPCION, TARLAC
    (School Address)

    MEDICAL CERTIFICATE
    (COACHES, ASSISTANT COACHES, CHAPERONE)

    11/16/2023
    (Date)
    To Whom It May Concern:

    This is to certify that I have personally examined RANDY O. BALUYUT


    Name
    age 37 sex MALE 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: VOLLEYBALL

    Physical Examination

    School/Intrams/District Meet Remarks/Findings:

    ________________________________________ Ht .173 cm Wt:60 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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