Certificat-medical-us.pdf
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Race name:
Race number:
MEDICAL CERTIFICATE
I, the undersigned Dr______________________________, Doctor of Medicine, Certify that the examination of Mr/Ms__________________________________ Date of birth: ______________________ Age: __________________ reveals no contraindications for participating in running competitions.
Medical certificate issued in (place):___________________________________
Date: ____________________
Doctors sign: _____________________ Doctors Stamp:
Race number:
MEDICAL CERTIFICATE
I, the undersigned Dr______________________________, Doctor of Medicine, Certify that the examination of Mr/Ms__________________________________ Date of birth: ______________________ Age: __________________ reveals no contraindications for participating in running competitions.
Medical certificate issued in (place):___________________________________
Date: ____________________
Doctors sign: _____________________ Doctors Stamp:
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