Medical Diagnostics Form For Athletes With Physical Impairment Page 3
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3Athlete Evaluation Consent Form
1. I agree to undergo the Athlete Evaluation process detailed in the IPC Powerlifting
Classification Rules and Regulations and administered by a designated IPC Powerlifting
Classification Panel. I understand that this process may require me to participate in sport-
like exercises and activities which may include me being observed whilst competing. I
understand that there is a risk of injury in participating in exercises and activities. I confirm
that that I am healthy enough to participate in Athlete Evaluation.
2. I understand that I have to comply with the requests made by the Classification Panel. This
includes providing sufficient documentation so as to allow a Classification Panel to
determine whether I comply with the eligibility requirements for IPC Powerlifting.
I
understand that if I fail to comply with any such request then Athlete Evaluation may be
suspended without a Sport Class being allocated to me.
3. I understand that Athlete Evaluation requires me to give my best effort, and that any
Intentional Misrepresentation of my skills, abilities and/ or the degree of my Impairment
during Athlete Evaluation may result in me facing disciplinary action (see IPC Intentional
Misrepresentation Rules in the IPC Handbook, Section 2, Chapter 1.3).
4. I understand that Athlete Evaluation is a judgment process and I agree to abide by the
judgment of the Classification Panel. If I do not agree with the decision of the Classification
Panel, I agree to abide by the Protest process as defined in the Classification Regulations.
5. I agree to be videotaped and photographed during the Athlete Evaluation process and that
this may include my activity on and off the field of play during the Competition.
6. I agree and consent to IPC Powerlifting processing my personal data in any format, including
my full name, country, date of birth, sport, Sport Class, Sport Class Status and relevant
medical information. I agree and consent to my name, country and Sport Class and Sport
Class Status being published by IPC Powerlifting and shared with third parties such as
Competition Organisers.
I wish to assist IPC Powerlifting in developing the Classification system and therefore allow my
data collected during Athlete Evaluation and video material recorded during training and
competition to be used for research and educational purposes by IPC Powerlifting. I understand that
I may withdraw this consent at any time.
Printed name of the athlete
Signature
Date
Parent / Guardian*
Signature
Date
*This is mandatory if the Athlete is under eighteen (18) years of age.
IPC Powerlifting Athlete Evaluation Consent Form
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