GOOD SHEPHERD CHRISTIAN ACADEMY

OF BATANGAS
Arce Subdivision, Hilltop, Batangas City
Tel. No. 723 – 2308

MEDICAL CERTIFICATE
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 physically fit, during the time of examination, to join and compete in

BCPRISA SPORTS OLYMPIAD.

DIAGNOSIS:

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

REMARKS:

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

_______________________________
Physician/ Medical Officer
(Signature over printed name)
License No.: ___________________