3 N 1 CEAP Form
3 N 1 CEAP Form
3 N 1 CEAP Form
Name: ______________________________________________________________________
Last Name First Name Middle Name
_____________________________
Signature of Athlete
This is to certify that I have verified the personal records of the above-mentioned athlete and
found the same to be true and correct.
_____________________________________ ___________________________________
Sports Coordinator Coach
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MEDICAL CERTIFICATE
Date: __________________
TO WHOM IT MAY CONCERN:
This is to certify that ______________________________________ has been
thoroughly examined by me and that he/she is not suffering from weak of heart, defective lungs,
or some communicable disease that will endanger his/her health or the health of other people.
He/she is therefore physically and mentally fit to participate in the CEAP MINDANAO
GAMES for the school year 2022-2023.
__________________________________
(Signature over Printed Name of Physician)
License: __________________________
Date: ____________________________
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PARENT/GUARDIAN CONSENT
_____________________
Date
__________________________________
(Signature of Parents/Guardian over Printed Name)