Black Belt Promotion Test Registration Form | 3rd Poom / Dan

Promotion Test | Black Belt 3rd Poom/Dan

Black Belt Promotion Test Information

Referee Seminar, Written Test and Essay Submission:
Date: Saturday, March 23, 2024
Time: 3:00 PM - 4:00 PM
Essay Topic: "What a Black Belt Means to me” or "My Taekwondo Journey" (Minimum 500 words) 

Board breaking, Self-defence Seminar:
Date: Saturday, March 23, 2024
Time: 4:00 PM - 6:00 PM
Details: 5 Boards Provided (More available for purchase upon request)

Black Belt Practical Test:
Date: Saturday, April 27, 2024
Time: 7:30 PM (Subject to change)

Registration Deadline: Monday, March 11, 2024 (Complete Registration form including payment)

Black Belt Promotion Test Registration Fee: 3rd Dan/Poom $950.00 Plus Tax (Late Registration will incur in a $50 late fee)

Leadership Program and Instructor Subsidy up to $100.00 and $200.00 respectively
(The application form which was provided in the test email, must be submitted with the registration form. Upon review, you will be notified about the approval or rejection of your subsidy)

The registration fee includes the following.

  • Referee seminar and Written test (If fail, re-test fee: $50.00 + GST)
  • Board breaking seminar (Includes 5 boards) and Self-defence seminar (Additional Seminar fee:$100.00 + GST if you wish to attend the seminar again)
  • Black belt practical test (If fail, re-test fee: $300.00 + GST)

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

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

Test Applicant Information

You may put both if you know the translation
Street Address
Apt./Building/Suite #
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
An seperate email will be sent to you if the application is approved.

Black Belt 3rd Dan/Poom Test Requirement

Emergency Contact Information

Emergency Contact Name
Emergency Contact Name

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 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 $997.50 for the black belt promotion test fees.
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.