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Medical Certificate: (Arnis, Boxing, Taekwondo, Gymnastics, Wrestling & Wushu)

This medical certificate document contains 9 questions for athletes participating in Arnis, Boxing, Taekwondo, Gymnastics, Wrestling, and Wushu. The questions ask the athlete if they are currently being treated by a doctor, have ever been unconscious or had a concussion, been hit hard in the head recently, had headaches, bleeding problems, family history of sudden death, prior surgeries, hospital stays, or other medical conditions. The form must be signed by both the parent/guardian and athlete.

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Aloha Aguilar Brusas
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910 views2 pages

Medical Certificate: (Arnis, Boxing, Taekwondo, Gymnastics, Wrestling & Wushu)

This medical certificate document contains 9 questions for athletes participating in Arnis, Boxing, Taekwondo, Gymnastics, Wrestling, and Wushu. The questions ask the athlete if they are currently being treated by a doctor, have ever been unconscious or had a concussion, been hit hard in the head recently, had headaches, bleeding problems, family history of sudden death, prior surgeries, hospital stays, or other medical conditions. The form must be signed by both the parent/guardian and athlete.

Uploaded by

Aloha Aguilar Brusas
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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Republic of the Philippines

DEPARTMENT OF EDUCATION
________________________
(Region)
______________________________
(Division)
______________________________
(School)
______________________________
(School Address)

MEDICAL CERTIFICATE
(Arnis, Boxing, Taekwondo, Gymnastics, Wrestling &
Wushu)

QUESTION FOR ATHLETE: IF YES, EXPLAIN

1. Is a doctor currently treating you for anything?


___________________________________________________________________________
2. Have you ever been unconscious or had a concussion?
___________________________________________________________________________
3. Have you been hit hard in the head in the last 6 weeks?
___________________________________________________________________________
4. Have you had any headache in the last 2 week?
___________________________________________________________________________
5. Do you have any problem in bleeding?
___________________________________________________________________________
6. Does any disease run in your family ? Sudden unexpected death?
___________________________________________________________________________
7. Have you had any surgery?
___________________________________________________________________________
8. Have you ever had to stay in a hospital?
___________________________________________________________________________
9. Do you have any other medical condition?
___________________________________________________________________________

____________________________________ _____________________________
Name & Signature of Parent/Guardian Name & Signature
of Athlete

FOR PALARONG PAMBANSA ONLY


Republic of the Philippines
DEPARTMENT OF EDUCATION
________________________
(Region)
______________________________
(Division)
______________________________
(School)
______________________________Date:
Date: ______________________________
(School Address)
_______________________

FOR PALARONG PAMBANSA ONLY

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