VIDEOS ARE DUE 1 MONTH PRIOR TO THE TESTING DATE
Students testing for green belt rank or above must submit their video test as a YouTube link below. Make sure all information is accurate and only submit your link one time. Please note, video tests take
up to 4 weeks
to review. Results and confirmations will be emailed to the email address you provide below. Questions - email
coach.v@kaizenkaratemd.com
. Lastly, students must register and pay for the test PRIOR to submitting the video links below.
Student Name
*
First Name
Last Name
Parent Email
*
example@example.com
Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Name of primary instructor
*
Coach V
Coach Chris
Coach David
Instructor's name is not listed above
Date of Belt Test
*
January 6th 2025
Current belt rank
*
white
white with orange stripe
white w/black stripe
orange
Yellow
Green
Purple
Blue
Brown
Brown with Black Stripe
Red
Testing for the following belt rank (must test for the next belt rank in order - no skipping belt ranks)
*
White
White with orange stripe
White w/black stripe
Orange
Yellow
Green
Purple
Blue
Brown
Brown with Black Stripe
Red
Red with Black Stripe
Class location (eg. East Silver Spring ES, Cleveland Park Club, etc)
*
What color stripes do you currently have on your belt?
*
blue (positive attitude)
yellow (technique)
green (sparring)
red (master form)
white (teaching - testing for brown and above only)
yellow (JuJitsu - testing for brown and above only)
orange (summer camp)
purple (fitness / flexibility - not mandatory - optional)
light blue (assisted as a sparring partner on 10 black belt exams or more)
What was the date of your last promotion? Please be as accurate as possible. Check your last certificate of rank for the date if needed.
*
-
Month
-
Day
Year
Date
Patches - do you have all the correct patches on your gi top?
*
Yes
No
Select the belt rank you are testing for below (only choose 1)
*
prev
next
( X )
Testing for White Belt with Orange or Black Stripe
$
45.00
Testing for Orange & Yellow Belt Test
$
45.00
Green Belt Test
$
50.00
Purple Belt Test
$
50.00
Blue Belt Test
$
65.00
Brown Belt Test
$
80.00
Brown Belt with Black Stripe Test
$
80.00
Red Belt Test
$
80.00
Red Belt with Black Stripe Test
$
80.00
Submit
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