Name

Republic of the Philippines

Department of Education
Region IV-A CALABARZON
Division of Laguna
District of San Pedro



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 have found that he/she is fit to join and
compete in the lower meets up to Palarong Pambansa Program.
I further certify that he/she is within the age requirement.

Event: ___________________________

Physical Examination

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






____________________________
Physician/Medical Officer
(Signature over printed name)
License No. ____________
PTR.: ________________
Date: ________________



Name
Republic of the Philippines
Department of Education
Region IV-A CALABARZON
Division of Laguna
District of San Pedro



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 ALAN TROY P. DE LOA age 11.9
sex M born on February 24, 2001 and have found that he/she is fit to join and compete in the
lower meets up to Palarong Pambansa Program.
I further certify that he/she is within the age requirement.

Event: VOLLEYBALL

Physical Examination

Height 133 cm Weight: 26 kg Blood Pressure
Pulse, Resting Respiratory Rate
Other Remarks:






____________________________
Physician/Medical Officer
(Signature over printed name)
License No. ____________
PTR.: ________________
Date: ________________



Name
Republic of the Philippines
Department of Education
Region IV-A CALABARZON
Division of Laguna
District of San Pedro



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 JOSEPH R. AMER age 11 sex M
born on March 24, 2002 and have found that he/she is fit to join and compete in the lower meets
up to Palarong Pambansa Program.
I further certify that he/she is within the age requirement.

Event: SIPA TAKRAW

Physical Examination

Height 138 cm Weight: 33 kg Blood Pressure
Pulse, Resting Respiratory Rate
Other Remarks:






____________________________
Physician/Medical Officer
(Signature over printed name)
License No. ____________
PTR.: ________________
Date: ________________



Name
Republic of the Philippines
Department of Education
Region IV-A CALABARZON
Division of Laguna
District of San Pedro



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 JACKSON REI G. HILOTIN III age
10.7 sex M born on December 12, 2001 and have found that he/she is fit to join and compete in
the lower meets up to Palarong Pambansa Program.
I further certify that he/she is within the age requirement.

Event: SIPA TAKRAW

Physical Examination

Height 133 cm Weight: 32 kg Blood Pressure
Pulse, Resting Respiratory Rate
Other Remarks:






____________________________
Physician/Medical Officer
(Signature over printed name)
License No. ____________
PTR.: ________________
Date: ________________