Request for Exemption Form

Request for Exemption Form
For Member Use
Name *

First Name Last Name
E-mail *
example@example.com
Phone Number *
Describe Reason for Request for Exemption: *
Please provide as much detail as possible. For injury or medical related reasons, a doctor's note is required.
File Upload

Attach any relevant documentation to support your case. Cost of a medical note may be reimbursed pending Board approval. Must include payment receipt.
Cancel of
To be completed by Ontario Weightlifting Association
Decision (including rationale):
Approved by:

Mike Miller David Di Donato Paul Vilchez Lara Ferretto George Vlahos
Ontario Weightlifting Association Signature:
The Ontario Weightlifting Association recognizes the right of privacy of individuals with respect to their personal information. All information collected will be kept confidential.

Requests will be reviewed by the Executive Board and you will be contacted within 3-5 business days with a decision.
Should be Empty:

For Member Use