Republic of the Philippines

Department of Education
VI – Western Visayas
(Region)
SIPALAY CITY
(Division)

M E D I CAL C E RT I FI CAT E

September 6, 2019
(Date)

To Whom It May Concern:

This is to certify that I have personally examined LIAN EMS M. PADEROG

Name

age 14 sex Male born on October 6, 2004 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: TABLE TENNIS

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
VI – Western Visayas
(Region)
SIPALAY CITY
(Division)

M E D I CAL C E RT I FI CAT E

September 6, 2019
(Date)

To Whom It May Concern:

This is to certify that I have personally examined JOHN REY D. MENDOZA

Name
age 12 sex Male born on March 18, 2007 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: TABLE TENNIS

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
VI – Western Visayas
(Region)
SIPALAY CITY
(Division)

M E D I CAL C E RT I FI CAT E

September 6, 2019
(Date)

To Whom It May Concern:

This is to certify that I have personally examined QUEEN JOLINA V. ORQUIJO age
Name
15 sex Female born on October 19, 2003 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: BADMINTON

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
VI – Western Visayas
(Region)
SIPALAY CITY
(Division)

M E D I CAL C E RT I FI CAT E

September 6, 2019
(Date)

To Whom It May Concern:

This is to certify that I have personally examined CHRISHA MAE G. TESA age 14
Name
sex Female born on December 24, 2004 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: BADMINTON

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: ________________