Junior Black Belt Application

First Name *

Last Name *

Phone *

Email *

Once you have submitted your application we will contact you to reserve a meeting. At least one parent must be present in this meeting. Please indicate if you would prefer an in person or a zoom meeting. *

Parents, please rate your child's home report based on them being respectful, cooperative and having a positive attitude. *

Parents, please rate your child's school report based on them being respectful, cooperative and receiving good grades. *

My commitment level out of 10, to achieving Junior Black Belt is... *

I have or will attend a min. of 26 classes for every 4-month session/unit... *

I have the Effort and Attitude of a Champion and always do my best on and off the mat. *

I will continue to practice at home to ensure my skill level before testing. If I need extra help I will ask for it. *

I will complete all 3 Kung Fu Quests before their due date. *

I understand that if I do not successfully complete all requirements during the initial evalutaion period my testing cycle will be postponed 30 to 45 days. It is possble not fullfilling all requirements more than once will result in being moved into the next testing cycle (season). *

I understand that the Junior Black Belt Test is divided into 3 different tests and if I fail any of the 3 tests I will receive a second attempt at passing that test approximately 30 to 45 days later. Failing the test a second time will result in being moved to the next testing cycle (season). *

I undertand that each test begins with a written quiz and if I fail the quiz I will get one more opportunity to write and pass the quiz in the very next class. If I fail I will be moved to the next testing cycle (season). *

Complete a brief paragraph or two on your reasons for wanting to become a Jr. Black Belt and what you think Black Belt stands for. *

Please indicate how you would like to have the Junior Black Belt Testing Fee processed by selecting one of the following options: Direct Billing, In Person Payment, Online Payment. *