8/16/2019 Swimming Medical Consent Letter_ Classes for Classes II to v 2016

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 DPS - Modern Indian School

Doha, Qatar

 APPLICATION for Participating in Swimming ClassName :

Birth Date :

Nationality :

Class :

Telephone :

Address :

Email :

Pledge

I ___________________________father / Guardian of ____________________ Studying in

 ___________hereby pledge to allow my ward for Swimming Class on my own responsibility and

he / she doesn't suffer from any of the following that bar him / her from participating in the

class.

 

Neurogenic as spasmademic :

  Circulatory :

  Respiratory :

  Skin Diseases :

Signature of Parent

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Medical Check-up has been conducted on _____________and he proved to be:

1- Medically Fit.

2- Medically unfit.

For participating in Swimming Class.

Date:

Doctor:

Signature of Doctor