Adaptive Athlete Application Form

Name*

First NameLast Name

Date of Birth*

Date

Email*

Confirmation Emailexample@example.com

Are you currently a member of USA Powerlifting?*

Enter USA Powerlifting Member ID

Adaptive Athlete Division Information

Please describe your impairment in medical terms*

Please describe what rule(s) you cannot 100% adhere to (if you can adhere to 100% of the rules, please state this)*

Please describe what accommodations are required (if no accomodations are required, please state this)*

Next Competition. In this section, you will be asked to provide details of the next competition you plan to enter. If your request to be in the Adaptive Athlete division is approved, an approval letter will be created and it will be sent to the following people:

you (at the email provided in this application)
the USA Powerlifting National Office
the meet director(s) of the next meet you plan to enter

Importantly, your private medical information will not be disclosed in the letter. The letter will simply list the accommodation(s) and/or waiver(s) for technical rules of performance you have been granted.

When the National Office receives your approval letter, your membership card will be updated to reflect your division as Adaptive Athlete.

Prior to every future event you enter, it is your responsibility to provide the meet director(s) with a copy of your approval letter so they can make sure that the referees are aware of any needed accommodation(s) and/or waiver(s) for technical rules of performance.

Information about events (name, date, city, state, sanction number, meet director, meet director email) can be found on the USA Powerlifting Calendar.

Name of next event you intend to enter (write "N/A" if you do not have a specific event planned at this time)*

Example: Texas State Championship

Date of next event you intend to enter (write "N/A" if you do not have a specific event planned at this time)*

Example: January 18, 2025 or 01/18/25

City and state of next event you intend to enter (write "N/A" if you do not have a specific event planned at this time)*

Example: San Antonio, TX

Sanction number of next event you intend to enter (write "N/A" if you do not have a specific event planned at this time)*

Example: TX-2025-01

Name of meet director of next event you intend to enter (write "N/A" if you do not have a specific event planned at this time)*

Example: John Smith

Email address of meet director of next event you intend to enter (write "N/A" if you do not have a specific event planned at this time)*

Confirmation Emailexample@example.com

Any comments, questions, or concerns?

By signing below, I agree to the following terms:

I affirm that I have read the description of the Adaptive Athlete division and that I meet the eligibility criteria for that division
I affirm that all the information I provided in this form is accurate and truthful
I understand that as a condition of approval for participation in USA Powerlifting, I may be asked to provide an official letter from a physician that:
- Documents the impairment/diagnosis
- Supports participation in the sport of powerlifting

Signature*

Adaptive Athlete Application Form

By signing below, I agree to the following terms:

Documents the impairment/diagnosis

Supports participation in the sport of powerlifting