PHYSICAL EXAMINATION (Must be completed by a Physician, PAC, or CRN)

(A current school or sports physical may substitute, if done during the current school
year. A photocopy must be included in YMRB.)

Height _______ Weight ___________ BP _________ Vision Screen ____________

Hearing ______________________________ Lungs ________________________

Heart Rate _______________ Rhythm ______________ Hernia ______________

Neurological Examination ____________________

Are there any restrictions or accommodations needed for the following activities?

Activities

Yes

No

Remarks (“Yes” require
remarks)

Competitive Sports







Physical Training







Swimming







Classroom







Other











I, certify that ____________________, is/ is not physically and medically fit to
participate in the Young Marines.

Please provide additional remarks or instructions, if participation in the Young Marines is
conditional due to any medical conditions not provided in the remarks above.
________________________________________________________________________
________________________________________________________________________
_________________________________________________________

Examiner’s Signature ____________________________ Date of Exam _________

Print Examiner’s Name________________________ Title ____________________

Office Address ________________________________________

City _________________________State _______ Zip Code __________

Office Telephone Number (____)_________________





(YMMEDFORM4)