Adult Testing Form Deputy 1 To Deputy 2 Belt (Page 2 of 2) in pdf

Adult Testing Form Deputy 1 To Deputy 2 Belt Page 2

Exam Request Form

Student Name: ______________________________________

Today’s Date: ___________

Start Date: _____________

Exam Date: _____________

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Your goal is to take the Black Belt exam on:

Spring

Fall Year:_____________

Please list 3 areas in which you have improved since starting our program:

Please list 3 areas in which you wish to make improvements:

Please list 3 actions you will take to achieve these improvements:

The following is a list of special services that we offer.

Please check ones of interest so we can send you more information about them:

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Private Lesson

Black Belt Club

Self Defense Seminars for Women

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Weapon Class

Sparring Class

Birthday Parties

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Demo Team

Schedule a Demo Team event

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Please

send

me free

gift

certificates to

with friends and family

Thank you for taking the time to complete this form.

Please be sure to sign and return this form one week prior to your exam.

$100

□

Exam Fee:

Check #

Cash

Credit Card

Please make check payable to: Yong-In Aurora Martial Arts

Student Signature: ____________________________________________

Adult Testing Form Deputy 1 To Deputy 2 Belt Page 2