Belt Test Application

Belt Test Application

This Application Needs to be fill out for Each Student Separately
Do you see your child's name on the list at BELT TEST LIST

Student requirements
Student Name*

First NameLast Name
Parent Name *

First NameLast Name
Email*
example@example.com
Pick the Belt Color Your Child will be Testing For?*

No belt Testing For White BeltWhite Belt Testing For Advanced White BeltAdvanced White Belt Testing For Yellow BeltYellow Belt Testing For Orange BeltOrange Belt Testing For Advanced Orange BeltAdvanced Orange Testing For Green BeltGreen Belt Testing For Blue BeltBlue Belt Tesing For Purple BeltPurple Testing For Advanced Purple BeltAdvanced Purple Testing For Brown BeltBrown Belt Testing For Red BeltRed Belt Testing For Red/Black Belt
Pick Your Child Belt Test Date*

Friday, October 20, 2023 At 5:30 PMFriday, November 17, 2023 At 6 PMFriday, December 15, 2023 At 6 PMFriday, January 26, 2024 At 6 PMFriday, February 23, 2024 At 6 PMFriday, March 15, 2024 At 6 PMFriday, April 26, 2024 At 6 PMFriday, May 31, 2024 At 6 PMFriday, June 14, 2024 At 6 PM
List 2-3 achievable improvements for your child before the next belt test.*
"Examples: Cleaning their room, helping with household chores, showing respect to adults, making their bed, etc."
Below Chart is optional
Courtesy, Respect to others

ExcellentSatisfactoryAverageNeeds Improvements
Self Control- Controlling Mind & Body

ExcellentSatisfactoryAverageNeeds Improvements
Perseverance- Working Hard and not giving up

ExcellentSatisfactoryAverageNeeds Improvements
Listening and following direction

ExcellentSatisfactoryAverageNeeds Improvements
Help around the house and chores

ExcellentSatisfactoryAverageNeeds Improvements
Homework and School work

ExcellentSatisfactoryAverageNeeds Improvements
Taking responsibility for actions

ExcellentSatisfactoryAverageNeeds Improvements
Treating brother/sister?

ExcellentSatisfactoryAverageNeeds Improvements
Appropriateness language

ExcellentSatisfactoryAverageNeeds Improvements
Thinking and analyzing before Action

ExcellentSatisfactoryAverageNeeds Improvements
Helping Others

ExcellentSatisfactoryAverageNeeds Improvements
Over all Behavior

ExcellentSatisfactoryAverageNeeds Improvements
Note to Staff (Please let us know if you have any concerns or questions)
Apply Coupon
Get Discount
Total Fee
Your Test Fee
Your Test Fee

prevnext( X )
USDDescription
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*

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

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Belt Test Application

Below Chart is optional