International Chayon-Ryu Martial Arts Association kimsookarateincorporated



Дата22.04.2016
Памер10.69 Kb.
#17639

International Chayon-Ryu Martial Arts Association


KIMSOOKARATEINCORPORATED


World Headquarters 713-681-9261

www.KimSooKarate.com

Doors open 8:30 am



Test starts 9:30 am


Please print all information clearly

If we make any mistakes on your certificate, we will replace it for free. If you make any mistakes, it will cost you $5 to replace it – write legibly.

Name:_______________________________________________________Birth Date:____________________


Student #:________School: Central Florida Chayon Ryu Test:#___________Test Date:_____________________

Address:__________________________________________City, State, Zip:____________________________

Date Started:___________Date of Last Promotion:_____________Present Rank:________________________

Work #:__________________Home #:______________________Pager/Cellular #:______________________


Occupation:__________________________Email:________________________________________________

Do you meditate before every practice session? No Rarely Sometimes Most of the Time Yes

Do you take an active role in cleaning your dojang? No Rarely Sometimes Most of the Time Yes

Do you arrive at least 15 – 30 minutes before class? No Rarely Sometimes Most of the Time Yes

Do you wear shoes before entering your school? No Rarely Sometimes Most of the Time Yes

Do you try to motivate yourself and others in class? No Rarely Sometimes Most of the Time Yes


I hereby agree to waive any claims or rights I might otherwise have to take legal action against Kim Soo Karate, Inc., its principles, employees, instructors, and/or agents for injuries to me on account of these activities. I further agree to indemnify and hold harmless Kim Soo Karate, Inc., it’s principals, instructors, and agents, for all claims, by whomsoever presented, that may be presented as a result of injuries or damages to myself. I agree that I have carefully read this waiver and release and fully understand it is a release of liability. I further agree to release Kim Soo Karate, Inc. from any liability for loss or theft of personal property.
I further agree to indemnify and hold harmless Kim Soo Karate, Inc., its principals, employees, instructors, and agents, for all claims including claims alleging that injuries or damages were caused by the negligence of Kim Soo Karate, Inc., it’s principles, instructors, and/or agents.


Signature (in ink):_______________________________Guardian (in ink):________________________________

Testing Fee:_________$35.00___________________Registrar:_____________________________________

All judges should initial at bottom before giving grades

Extensive comments, corrections and suggestions should be written on the back

Forms:____________________________________________________________________Written Test:_____________


Basic Movements:__________Kicking:_________Skipping:_________Basic Self Defense:________Practicals:________

Formal 1-step/3-step:_______ Hapkido:_________Falling:__________Knife/Gun Defense:________Breaking:________

Chung Bong Avoiding:______Sparring:_________Attitude:_________Han Son Daryon:__________Tightening Ways___

General Comments__________________________________________________________________________________

__________________________________________________________________________________________________
Forms Judge:__________Self Defense Judge:__________Sparring Judge:__________
Orange Yellow Green Blue Purple Purple Brown Brown Black Belt Size________

9 8 7 6 5 4 3 2 1 1


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