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 Zach
Coach David
Coach Nina
Coach Skylar
Coach James
Instructor's name is not listed above
Your Instructor Name
*
Date of Belt Test
*
Saturday, Oct 18th, 2025
Belt Test Mode
*
Received an Invitation from Kaizen Karate Office
Make up Belt Test
Current belt rank
*
White with orange stripe (3-4 yrs old)
White w/black stripe (5yrs and older)
Orange
Testing for the following belt rank (must test for the next belt rank in order - no skipping belt ranks)
*
Orange
Yellow
Class location (eg. East Silver Spring ES, Cleveland Park Club, etc)
*
What color stripes do you currently have on your belt?
*
No Stripes
blue (positive attitude)
yellow (technique)
green (sparring)
orange (summer camp)
purple (fitness / flexibility - not mandatory - optional)
Select the belt rank you are testing for below (only choose 1)
*
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( X )
Orange Belt Test E - certificate
You will get an electronic certificate from Kaizen Karate. If you opting for this option.
$
50.00
Orange Belt Test Physical - certificate
You will get a physical certificate from Kaizen Karate. If you opting for this option. Please do share your shipping address.
$
60.00
Yellow Belt Test E - certificate
You will get an electronic certificate from Kaizen Karate. If you opting for this option.
$
50.00
Yellow Belt Test Physical - certificate
You will get a physical certificate from Kaizen Karate. If you opting for this option. Please do share your shipping address.
$
60.00
Shipping Address ( We will ship Physical Certificate to this address )
*
Street Address
Street Address Line 2
City
State
Zip Code
Submit
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