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

Promotion Test - Black Belt 2nd Poom/Dan

Promotion Test Information

Test Date: December 4, 2021
Time: 3:00 PM - 6:00 PM
Registration Deadline: November 6, 2021 (Complete Regstration form including payment)
Belt Promotion Test Registration Fees: 2nd Dan/Poom $700.00 Plus Tax
Adidas Black/Poom Belt Dobok Included if test is completed with a passing grade
Adidas Black/Poom Belt Included if test is completed with a passing grade
Kukkiwon Certificate Application Included if test is completed with a passing grade

Please complete the leadership and instructor subsidy form to see if you qualify for a subsidy for your promption test fee. A maximum of $200.00 can be applied if all requirements are fulfilled.

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
Please put the desired dobok size. 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 upload size: 268.44MB
Maximum upload size: 268.44MB
Choose In-person payment if application form is submitted. An seperate email will be sent to you if the application is approved.

Payment Method

Black Belt 1st Dan/Poom Test Requirement

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. 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 Total