Unused | Black Belt Promotion Test Seminar Registration Form Unused | Black Belt Promotion Test Seminar Registration Form For seminar attendees who are participating in the black belt test seminar months in advance of their expected promotion test, the seminars will be charged in advance of the test. When you pay for the registration for the black belt test, the difference will be charged, rather than the full amount of the testing registration fee. For seminar attendees who are retaking the Referee Seminar and Written Test and/or Board Breaking and Self-Defence Seminar, the seminar re-take fee will not be taken into account when completing the black belt test registration. Test Applicant Information Name of Test Candidate * Name of Test Candidate First First Last Last Membership Number * Date of Birth * Age Weight (kg) * Belt Level * Red-Black to 1st Poom/Dan1st Poom/Dan to 2nd Poom/Dan2nd Poom/Dan to 3rd Poom/Dan Seminar Registration * 001_Referee Seminar & Written Test Plus Board Breaking & Self-Defence Seminar (Attending the seminar ahead of time) 002_Re-attend Board Breaking and Self-Defence Seminar 003_Retake Referee Seminar and Written Test Board Breaking Seminar Choose the technique you would want to test break 5 boards are provided for the seminar Extra board(s) can be purchased at the dojang to allow for additional practice Power Breaking will be modified for children under 25 KG Since the thickness of boards will differ based on your age and weight, if you wish to practice with more than the 5 provided boards, please bring cash to the seminar to purchase any extra boards you may need. Please refer to black belt test breaking criteria for your reference Red-Black Belt to 1st Poom / Dan * (1 Board) Hand Technique | Punch (1 Board) Hand Technique | Knife Hand Chop (1 Board) Kicking Technique | Frontsnap Kick (1 Board) Kicking Technique | Roundhouse Kick (1 Board) Kicking Technique | Side Kick (Also tested in Yellow-Green Belt) (1 Board) Kicking Technique | Back Kick (Also tested in Green-Blue Belt) (1 Board) Kicking Technique | Backhook Kick (Also tested in Blue-Red Belt) (1-2 Boards) Power Breaking | Side Kick or Back Kick *(2 boards for 13 yrs & up Male, Over 68.1 KG) (1 Board) Power Breaking | Palm Strike or Punch or Knife Hand Chop (1 Board) Jump Kick | Jump Side Kick (Jump over obstacles) (1 Board) Jump Kick | Jump High Frontsnap Kick (Top of the fist when hand raise overhead) 1st Poom / Dan to 2nd Poom / Dan * (1-2 Boards) Hand Technique | Punch *(2 boards for 13 yrs & up Male, Over 68.1 KG) (1-2 Boards) Hand Technique | Knife Hand Chop *(2 boards for 13 yrs & up Male, Over 68.1 KG) (1-2 Boards) Hand Technique | Elbow Strike *(2 boards for 13 yrs & up Male, Over 68.1 KG) (1 Board) Kicking Technique | Jump Roundhouse Kick (1 Board) Kicking Technique | Jump Side Kick (1 Board) Kicking Technique | Jump Back Kick (1 Board) Kicking Technique | Jump Backhook Kick (1-3 Boards) Power Breaking | Side Kick or Back Kick (2 boards) *(1 board for 12 yrs & under, Under 45 KG) *(3 boards for 13 yrs & up Male, Over 68.1 KG) (1-3 Boards) Power Breaking | Palm Strike or Punch or Knife Hand Chop (2 boards) *(1 board for 12 yrs & under, Under 45 KG) (2 boards) | Jump Multiple Kicks 1 (2 boards) | Jump Multiple Kicks 2 2nd Poom / Dan to 3rd Poom / Dan * (1 Board) Hand Technique | Inch Punch (1 Board) Hand Technique | Inch Knife Hand Chop (1 Board) Hand Technique | Inward Knife Hand Chop (1 Board) Kicking Technique | 360 Jump Roundhouse Kick (1 Board) Kicking Technique | 360 Jump Side Kick (1 Board) Kicking Technique | 360 Jump Back Kick (1 Board) Kicking Technique | 360 Jump Backhook Kick (3-4 Boards) Power Breaking | Side Kick or Back Kick (3 boards) *(4 boards for 13 yrs & up Male, Over 68.1 KG) (3-4 Boards) Power Breaking | Palm Strike or Punch or Knife Hand Chop (3 boards) *(4 boards for 13 yrs & up Male, Over 68.1 KG) (3 boards) | Jump Multiple Kicks 1 (3 boards) | Jump Multiple Kicks 2 Total number of wooden board needed * Extra Wooden Board to Purchase * Waiver Information I hereby give permission for myself/my child to participate in Jeon Eui Taekwondo Black Belt Test Seminar. I understand that there is no refund for the Black Belt Test Seminar fee. For extenuating circumstances, the seminar may be postponed by providing written notice within 48 hours of the event. Only one postponement will be allowed, and it must be re-scheduled within one year of the initial date. All testing candidates must wear their full Jeon Eui dobok (uniform) with their associated belt at the test. No jewellery is allowed, and fingernails and toenails must be kept trimmed. Having read and understood all the information on this form, I hereby allow myself/my child to attend Black Belt Test Seminar. Name (Parent or Legal Guardian if under 19 years of age) * Name (Parent or Legal Guardian if under 19 years of age) First First Last Last Signature * signature keyboard Clear Sign by parent or legal guardian if under 19 years of age Date * Payment Total Subtotal GST (5%) Total If you are human, leave this field blank. Next Δ