Belt Test Application

Student Name *

First

Last

Parent Name *

First

Last

Email *

Pick the Belt Color Your Child will be Testing For? *

No belt Testing For White Belt
White Belt Testing For Advanced White Belt
Advanced White Belt Testing For Yellow Belt
Yellow Belt Testing For Orange Belt
Orange Belt Testing For Advanced Orange Belt
Advanced Orange Testing For Green Belt
Green Belt Testing For Blue Belt
Blue Belt Tesing For Purple Belt
Purple Testing For Advanced Purple Belt
Advanced Purple Testing For Brown Belt
Brown Belt Testing For Red Belt
Red Belt Testing For Red/Black Belt

Give your child 2-3 improvements that he or she can accomplish before next belt test. *

Example: clean room, help around the house, Respect adults, make their bed or ...

Below Chart is optional

Layout

Courtesy, Respect to others

Excellent
Satisfactory
Average
Needs Improvements

Self Control- Controlling Mind & Body

Excellent
Satisfactory
Average
Needs Improvements

Perseverance- Working Hard and not giving up

Excellent
Satisfactory
Average
Needs Improvements

Listening and following direction

Excellent
Satisfactory
Average
Needs Improvements

Layout

Help around the house and chores

Excellent
Satisfactory
Average
Needs Improvements

Homework and School work

Excellent
Satisfactory
Average
Needs Improvements

Taking responsibility for actions

Excellent
Satisfactory
Average
Needs Improvements

Treating brother/sister?

Excellent
Satisfactory
Average
Needs Improvements

Layout

Appropriateness language

Excellent
Satisfactory
Average
Needs Improvements

Thinking and analyzing before Action

Excellent
Satisfactory
Average
Needs Improvements

Helping Others

Excellent
Satisfactory
Average
Needs Improvements

Over all Behavior

Excellent
Satisfactory
Average
Needs Improvements

Note to Staff (Please let us know if you have any concerns or questions)

Your Test Fee

$ 0.00

Payment Option *

Pay Now By Credit, Debit Card or paypal (Preferred Method)
Add to my Invoice to Pay Later ($15.00 Fee)
I Paid

Let us know How was paid

Please Choose your Payment Method *

Card Number

Expiration Date

Security Code

Card Holder Name

Home
Calendar
Request Tryouts
Before & After School Program
Martial Arts Classes
Summer Camp
Students Info
Belt Test List
Birthday Party
Pay Tuition
Winter Party