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Certificate of Childs Medical Fitness 1

This document is a Certificate of Child's Medical Fitness issued by a pediatrician, confirming the child's health status for activities such as swimming training and school trips. It includes sections for the child's personal information, health insurance details, fitness assessment, vaccination status, allergies, and any long-term medication. The certificate is valid for one year unless the child's health changes during that period.

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Neha parveen
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2K views1 page

Certificate of Childs Medical Fitness 1

This document is a Certificate of Child's Medical Fitness issued by a pediatrician, confirming the child's health status for activities such as swimming training and school trips. It includes sections for the child's personal information, health insurance details, fitness assessment, vaccination status, allergies, and any long-term medication. The certificate is valid for one year unless the child's health changes during that period.

Uploaded by

Neha parveen
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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CERTIFICATE OF CHILD´S MEDICAL FITNESS

“Statement of Pediatrist”
Name: ___________________________________________________________________________

Date of Birth: _____________________________________

Health Insurance Company: _________________________ Policy No: ______________________

Place of Residence: ________________________________________________________________

Examining child:

Is physically fit*)

Isn´t physically fit*)

Is physically fit with restrictions:*) ______________________________________________________

I am confirming that the child:

Underwent regular vaccinations: YES - NO*) _____________________________________________

Is immune against infection (type/kind): _________________________________________________

Has permanent contraindications to vaccination (type/kind): _________________________________

Is allergic to: ______________________________________________________________________

Long-term medication use (type/prescription/dosage):


_________________________________________

Other:

________________________ ________________________
Date Stamp and signature
of the paediatrician

Confirmation is issued as proof of medical fitness of a child for swimming training, school trips, camps,
other sport and recreational events, etc. Confirmation is valid for one year from the date of publication,
unless there is a change of health in relation to disease during this period.

*) Delete if inappropriate or if there is nothing to fill, write N/A.

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