TFSS Form No 002 MC

Republic of the Philippines

Department of Education
_____III______
(Region)

Tarlac Province
To the Coach: Encode the name,
age,sex, place of birth then delete
this BOX!!!

(Division)

Moncada Catholic School

Name of School

M E D I C AL C E R T I F I C AT E
__________________
(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 lower meets and Palarong
Pambansa.

Event: ___________________________
Physical Examination
Date examined: _______________
Height
Pulse, Resting
Other Remarks:

Weight:

Blood Pressure
Respiratory Rate

________________________________________________________

Physician/Medical Officer
(Signature over printed name)

License No.
PTR.:
Date:

TFSS Form No 002 MC

Republic of the Philippines

Department of Education
_____III______
(Region)

Tarlac Province
(Division)

Moncada Catholic School

Name of School

M E D I C AL C E R T I F I C AT E
__________________
(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 lower meets and Palarong
Pambansa.

Event: ___________________________
Physical Examination
Date examined: _______________
Height
Pulse, Resting
Other Remarks:

Weight:

Blood Pressure
Respiratory Rate

________________________________________________________

Physician/Medical Officer
(Signature over printed name)

License No.
PTR.:
Date:

TFSS Form No 002 MC

Republic of the Philippines

Department of Education
_____III______
(Region)

Tarlac Province
(Division)

Moncada Catholic School

Name of School

M E D I C AL C E R T I F I C AT E
__________________
(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 lower meets and Palarong
Pambansa.

Event: ___________________________
Physical Examination
Date examined: _______________
Height
Pulse, Resting
Other Remarks:

Weight:

Blood Pressure
Respiratory Rate

________________________________________________________

Physician/Medical Officer
(Signature over printed name)

License No.
PTR.:
Date:

TFSS Form No 002 MC

Republic of the Philippines

Department of Education
_____III______
(Region)

Tarlac Province
(Division)

Moncada Catholic School

Name of School

M E D I C AL C E R T I F I C AT E
__________________
(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 lower meets and Palarong
Pambansa.

Event: ___________________________
Physical Examination
Date examined: _______________
Height
Pulse, Resting
Other Remarks:

Weight:

Blood Pressure
Respiratory Rate

________________________________________________________

Physician/Medical Officer
(Signature over printed name)

License No.
PTR.:
Date:

TFSS Form No 002 MC

Republic of the Philippines

Department of Education
_____III______
(Region)

Tarlac Province
(Division)

Moncada Catholic School

Name of School

M E D I C AL C E R T I F I C AT E
__________________
(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 lower meets and Palarong
Pambansa.

Event: ___________________________
Physical Examination
Date examined: _______________
Height
Pulse, Resting
Other Remarks:

Weight:

Blood Pressure
Respiratory Rate

________________________________________________________

Physician/Medical Officer
(Signature over printed name)

License No.
PTR.:
Date:

TFSS Form No 002 MC

Republic of the Philippines

Department of Education
_____III______
(Region)

Tarlac Province
(Division)

Moncada Catholic School

Name of School

M E D I C AL C E R T I F I C AT E
__________________
(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 lower meets and Palarong
Pambansa.

Event: ___________________________
Physical Examination
Date examined: _______________
Height
Pulse, Resting
Other Remarks:

Weight:

Blood Pressure
Respiratory Rate

________________________________________________________

Physician/Medical Officer
(Signature over printed name)

License No.
PTR.:
Date:

TFSS Form No 002 MC

Republic of the Philippines

Department of Education
_____III______
(Region)

Tarlac Province
(Division)

Moncada Catholic School

Name of School

M E D I C AL C E R T I F I C AT E
__________________
(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 lower meets and Palarong
Pambansa.

Event: ___________________________
Physical Examination
Date examined: _______________
Height
Pulse, Resting
Other Remarks:

Weight:

Blood Pressure
Respiratory Rate

________________________________________________________

Physician/Medical Officer
(Signature over printed name)

License No.
PTR.:
Date:

TFSS Form No 002 MC

Republic of the Philippines

Department of Education
_____III______
(Region)

Tarlac Province
(Division)

Moncada Catholic School

Name of School

M E D I C AL C E R T I F I C AT E
__________________
(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 lower meets and Palarong
Pambansa.

Event: ___________________________
Physical Examination
Date examined: _______________
Height
Pulse, Resting
Other Remarks:

Weight:

Blood Pressure
Respiratory Rate

________________________________________________________

Physician/Medical Officer
(Signature over printed name)

License No.
PTR.:
Date:

TFSS Form No 002 MC

Republic of the Philippines

Department of Education
_____III______
(Region)

Tarlac Province
(Division)

Moncada Catholic School

Name of School

M E D I C AL C E R T I F I C AT E
__________________
(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 lower meets and Palarong
Pambansa.

Event: ___________________________
Physical Examination
Date examined: _______________
Height
Pulse, Resting
Other Remarks:

Weight:

Blood Pressure
Respiratory Rate

________________________________________________________

Physician/Medical Officer
(Signature over printed name)

License No.
PTR.:
Date:

TFSS Form No 002 MC

Republic of the Philippines

Department of Education
_____III______
(Region)

Tarlac Province
(Division)

Moncada Catholic School

Name of School

M E D I C AL C E R T I F I C AT E
__________________
(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 lower meets and Palarong
Pambansa.

Event: ___________________________
Physical Examination
Date examined: _______________
Height
Pulse, Resting
Other Remarks:

Weight:

Blood Pressure
Respiratory Rate

________________________________________________________

Physician/Medical Officer
(Signature over printed name)

License No.
PTR.:
Date:

TFSS Form No 002 MC

Republic of the Philippines

Department of Education
_____III______
(Region)

Tarlac Province
(Division)

Moncada Catholic School

Name of School

M E D I C AL C E R T I F I C AT E
__________________
(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 lower meets and Palarong
Pambansa.

Event: ___________________________
Physical Examination
Date examined: _______________
Height
Pulse, Resting
Other Remarks:

Weight:

Blood Pressure
Respiratory Rate

________________________________________________________

Physician/Medical Officer
(Signature over printed name)

License No.
PTR.:
Date:

TFSS Form No 002 MC

Republic of the Philippines

Department of Education
_____III______
(Region)

Tarlac Province
(Division)

Moncada Catholic School

Name of School

M E D I C AL C E R T I F I C AT E
__________________
(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 lower meets and Palarong
Pambansa.

Event: ___________________________
Physical Examination
Date examined: _______________
Height
Pulse, Resting
Other Remarks:

Weight:

Blood Pressure
Respiratory Rate

________________________________________________________

Physician/Medical Officer
(Signature over printed name)

License No.
PTR.:
Date:

TFSS Form No 002 MC

Republic of the Philippines

Department of Education
_____III______
(Region)

Tarlac Province
(Division)

Moncada Catholic School

Name of School

M E D I C AL C E R T I F I C AT E
__________________
(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 lower meets and Palarong
Pambansa.

Event: ___________________________
Physical Examination
Date examined: _______________
Height
Pulse, Resting
Other Remarks:

Weight:

Blood Pressure
Respiratory Rate

________________________________________________________

Physician/Medical Officer
(Signature over printed name)

License No.
PTR.:
Date:

TFSS Form No 002 MC

Republic of the Philippines

Department of Education
_____III______
(Region)

Tarlac Province
(Division)

Moncada Catholic School

Name of School

M E D I C AL C E R T I F I C AT E
__________________
(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 lower meets and Palarong
Pambansa.

Event: ___________________________
Physical Examination
Date examined: _______________
Height
Pulse, Resting
Other Remarks:

Weight:

Blood Pressure
Respiratory Rate

________________________________________________________

Physician/Medical Officer
(Signature over printed name)

License No.
PTR.:
Date:

TFSS Form No 002 MC

Republic of the Philippines

Department of Education
_____III______
(Region)

Tarlac Province
(Division)

Moncada Catholic School

Name of School

M E D I C AL C E R T I F I C AT E
__________________
(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 lower meets and Palarong
Pambansa.

Event: ___________________________
Physical Examination
Date examined: _______________
Height
Pulse, Resting
Other Remarks:

Weight:

Blood Pressure
Respiratory Rate

________________________________________________________

Physician/Medical Officer
(Signature over printed name)

License No.
PTR.:
Date:

TFSS Form No 002 MC

Republic of the Philippines

Department of Education
_____III______
(Region)

Tarlac Province
(Division)

Moncada Catholic School

Name of School

M E D I C AL C E R T I F I C AT E
__________________
(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 lower meets and Palarong
Pambansa.

Event: ___________________________
Physical Examination
Date examined: _______________
Height
Pulse, Resting
Other Remarks:

Weight:

Blood Pressure
Respiratory Rate

________________________________________________________

Physician/Medical Officer
(Signature over printed name)

License No.
PTR.:
Date:

TFSS Form No 002 MC

Republic of the Philippines

Department of Education
_____III______
(Region)

Tarlac Province
(Division)

Moncada Catholic School

Name of School

M E D I C AL C E R T I F I C AT E
__________________
(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 lower meets and Palarong
Pambansa.

Event: ___________________________
Physical Examination
Date examined: _______________
Height
Pulse, Resting
Other Remarks:

Weight:

Blood Pressure
Respiratory Rate

________________________________________________________

Physician/Medical Officer
(Signature over printed name)

License No.
PTR.:
Date: