Indoor Adaptive Rowing Categorisation Request Form
To be assigned a World Rowing Indoor Adaptive Rowing Categorisation, this form must be completed in full. World Rowing holds the right to request further information, if additional information is required. World Rowing may require a virtual consultation and observation on a rowing machine prior to competition. The athlete will not be able to compete at any World Rowing Indoor Rowing event, until such time as the requested information is provided.
*Before starting to complete this form, please ensure the Medical Diagnostics Form for Indoor Adaptive Rowing Categorisation has been completed and signed by your Physician or Ophthalmologist/ Optometrist, and that you have prepared the mandatory supporting medical documentation.*
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Has your medical physician completed and signed the MDF form and provided all required additional information?
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Yes
No
Please upload your completed Medical Diagnostics Form in English and signed by a licensed Medical Physician or Licensed Ophthalmologist/Optometrist.
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If you have not completed the MDF Form, please download the file bellow and complete it before finishing this form.
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Athlete Information
Name
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First Name
Last Name
Gender
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Male
Female
Date of Birth
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/
Day
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Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Email
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example@example.com
Nationality
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Medical Information
To be eligible for Indoor Adaptive Rowing, an Athlete must have an impairment that is the direct result of an Underlying Health Condition which has resulted in a verifiable activity limitation.
Which of the following Permanent and Verifiable Impairments describe your impairment best?
Impaired Muscle Power - Spinal cord injury, Muscular Dystrophy, Brachial Plexus injury, Erb's Palsy, Polio, Spina Bifida, Guillain-Barre syndrome
Impaired Range of Movement - Arthrogryposis, Ankylosis, Post Burns, Joint Contractures
Limb Deficiency - Amputation resulting from trauma or congenital limb deficiency
Hypertonia/ Ataxia/ Athetosis - Cerebral Palsy, Stroke, Brain Injury, Multiple Sclerosis, Friedreich's Ataxia, Spinocerebellar Ataxia
Pain-based Impairment - CRPS, Arthiritis, Herniated Disc
Non-eligible World Rowing Impairment - FND, EDS, Psychological Impairments, Chronic Health Conditions, Chronic Fatigues Syndrome
Visual Impairment - IBSA B3 Standard
Intellectual Impairment - Autism, Low IQ, Down's Syndrome
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Please upload the following document bellow:
Manual Muscle Test Results
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Goniometric Measurements
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Photograph or X-ray of affected limb
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Modified Ashworth Scale
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VI Field Test
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IQ Test Result
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