1953-1955 Academic Catalog

f • f • ' ' •• ' I ' I ' • • • • • I I • I • ' • I ' • • I I • I ' • ' • • • • I ' • • • • • • • • I • • • • • • • • I • I • • • ' • I ' • ' • • I • , ' • ' I I • ' I I I • ' I • • • • • • • • • • I I I • ' • I PHYSICIANS CERTI FICATE of APPLICANT'S HEALTH EXAMINATION CEDARVILLE BAPTIST COLLEGE AND BIBLE INSTITUTE CEDARVILLE, OHIO J:>ate -------------------------------------------------------- Name of A pp Ii cant ------------------------------------------------------------------~------------------· __________ Ears- Right ----------------- Left__________________ Nose ---------------- Throat ----------------– Teeth ---------- Eyes ---------- Does applicant wear glasses? -----------------------------– ~eading only ------------- Heart ------------------ Murmurs -------------- Pulse ------------- Lungs ---------------------------------------------------------------------------------------------------------- P.M.H.: Chicken pox ____ Measles________ Whooping Cough --..----- Diphtheria -------- ·scarlet Fever ---------- Infantile Paralysis ------------- Pneumonia ------------- Is the applicant subject to sore throat? --------------- Common Colds ---------------– Headache ----------------- Tuberculosis ------------------ Rheumatic Fever -------------– Dysmenorrhea --------------------------- Is it necessary for the applicant to take any medications for any of the above con.ditions? If so state ------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------- Describe, if any, special weaknesses or limitations; abnormalities; injuries : -----------------·----·--------------------------------------------------------------------------·---------------------------- --------------------------------------------------------------------------------------------------·--------------------------- ---------------------------------------------------------------------------------------------· -------------------------------- ---------·----------------------------------------------------------------,---------------------------------------------------- ----------------------·--------------·---------------------------------------------- ·----------------------------- --·------·-- This is to certify that -------·-----------------------:--------------------------------------------------------- -- -- ----·-----------------------------------------------------------------------------------------------------------------·· ifi mentally fit ( unfit ( ) and physically fit ( ) for the demands of ) unfit ( ) student life in Cedarville Baptist College and Bible Institute, Cedarville, Ohio Signed --·-----·----·------·--------------------------------------- ------------------------ - M. D. Address -----------------------···--------------·--------------------------·----------·---------------- -----------------------------------------------------------------------·----·-------·-------· - L icense number ------·-----------------------------------·- -79-