Black Belt Promotion Test Registration Form | 2nd Poom / Dan

Promotion Test | Black Belt 2nd Poom/Dan

Black Belt Promotion Test Information

Referee Seminar, Written Test and Essay Submission:
Date: Saturday, July 13, 2024
Time: 3:00 PM - 4:00 PM
Essay Topic: "What a Black Belt Means to me” (Minimum 500 words)

Board breaking, Self-defence Seminar:
Date: Saturday, July 13, 2024
Time: 4:00 PM - 6:00 PM
Details: 5 Boards Provided (More available for purchase upon request)

Black Belt Practical Test:
Date: Saturday, August 24, 2024
Time: 3:30 PM (TBC)

Registration Deadline: Saturday, July 6, 2024 (Complete Registration form including payment)

Black Belt Promotion Test Registration Fee: 2nd Dan/Poom $800.00 Plus Tax (Late Registration will incur in a $50 late fee)

The registration fee includes the following.

  • Referee seminar and Written test (If failed, re-testing fee is $50.00 + GST)
  • Board breaking seminar (Includes 5 boards) and Self-defence seminar (Re-attending is available for $100.00 + GST)
  • Black belt practical test (If failed, re-testing fee is $250.00 + GST)

If test is completed with a passing grade, the following are included in each black belt test fees,

  • Adidas Black/Poom Belt Dobok
  • Adidas Black/Poom Belt
  • Kukkiwon Certificate Application

Test Applicant Information

First
Last
You may put both if you know the translation
Address
Street Address
Apt./Building/Suite #
City
State/Province
Zip/Postal
Country
Poom Uniform will be used for 14 years old and Under | Dan Uniform will be used for 15 years old and older
Current Size on Belt

Maximum file size: 5MB

(Required For Kukkiwon Certificate Application. Please have a clean background. It will be used on your Black Belt Kukkiwon ID Card)

Black Belt 2nd Dan/Poom Test Requirement

Leadership Program (Volunteers) may be eligible to receive a $100.00 subsidy

Paid Instructors may be eligible to receive a $200.00 subsidy. 
You may be eligible to the Leadership Program & Instructor Program Subsidy.

  • Attendance with less than 10% of Absence from your scheduled volunteer sessions
  • Minimum 70% (80% for Paid Instructors) of attendance from our monthly leadership and instructor workshop
Please choose the following
If the aforementioned information is correct, unfortunately, you are not eligible for the subsidy.

Pending review, your request for our leadership subsidy or instructor subsidy has been noted.

You will be notified about your submission within 5 business day.

Staff additional credit

Maximum file size: 3MB

Emergency Contact Information

Emergency Contact Name
Emergency Contact Name
First
Last

Waiver Information

I hereby give permission for myself/my child to participate in Jeon Eui Taekwondo Black Belt Promotion Test. I understand that there is no refund on black belt promotion test fee. For extenuating circumstances, the black belt test may be postponed by providing written notice within 48 hours after the test. Only one postponement will be allowed and it must be re-scheduled within one year. You may asked to provide proof for the extenuating circumstances if test postponement is requested. Having read and understood all the information on this form, I hereby allow myself/my child to attend Black Belt Promotion Test. The Waiver Forms that I have signed at Jeon Eui Taekwondo will also apply to the Black Belt Promotion Test.

Sign by parent or legal guardian if under 19 years of age

Payment Information

Payment Method
Bank Withdrawal Authorization
I/We hereby authorize Jeon Eui Taekwondo to direct my Financial Institution to debit my/our bank account, on file for the black belt promotion test fees. The fee will $840.00 barring any subsidy approval or credit that will be subtracted from the amount owing.
If any payment is returned by the Bank for any reason, I/we will be responsible for Non-Sufficient Funds (NSF) and/or administration charges.
I/We, the undersigned, have read, understood, and agree to the terms and conditions of this agreement.