Medical certificate for admission to fitness and sport

 

The undersigned doctor in medicine

Name and first name:

 

certifies that:

Name:

First name:

Date of birth:

Residing in:

Street nr. bus

Postal Code, town:

 

 

o is admitted to practise sports and fitness practice.

o is admitted to practise sports and fitness activities, with the exception of

.........................................................................................................................................................................................................................................................................................................................................................................................................

o is not admitted to practise sports and fitness practice.

(cross the correct answer)

 

Signature and date:

Stamp of the doctor:  

            

 

 

Bring this certificate, completed, to our first appointment.

Miguel Milo

Master in physical education

www.miguelmilo.com

0485/ 84 40 83