Examinerʼs Signature

Transcription

1 Y.C. Kim Black Belt Society WHITE to YELLOW Belt Size Student s Name Date of Birth / / Age Address City Zip Home Phone Cell Phone School Beavercreek South Community YMCA If at any time I violate any of the following three (3) rules and regulations governing the Y.C. KIM BLACK BELT SOCIETY, I hereby agree that the organization reserves the right to suspend my rank or status. 1. The purpose of Taekwondo is to improve both mental and physical health and all members must uphold and protect the honor and prestige of Taekwondo. 2. Members are forbidden to use Taekwondo techniques to provoke and challenge innocent persons; and such use will make offending members subject to disciplinary action. 3. The Y.C. KIM BLACK BELT SOCIETY is the sole judge of my qualifications and achievements in this Martial Art. I agree that the promotion examination fee which has been paid is not refundable under any circumstances and also that I will accept any grade or belt rendered by this college with complete satisfaction, neither demanding nor protesting for a higher belt or grade. OFFICE USE ONLY: Total Fee paid: Circle one: Cash Check # Received by: Date Forms Basic Form 1 Basic Form 2 Basic Form 3 Step Sparring (3 step) Step Sparring 1 Step Sparring 2 Step Sparring 3 Step Sparring 4 Step Sparring 5 Technique/Spirit Side Kick Other OVERALL COMMENTS: Attitude/Class Pass Conditional Retest Grade Examinerʼs Signature

2 Y.C. Kim Black Belt Society WHITE to YELLOW Score /100 Scored by: Student s Name Age Date / / MATCHING (3 points each = 30 points) 1. Be loyal always finishing what you start 2. Be obedient never retreating in battle 3. Be lovable to your country 4. Be cooperative to your parents 5. Be respectful with brothers and sisters 6. Be faithful with the use of Taekwondo, using it justly 7. Be honorable with your elders 8. Be discrete with your friends 9. Be brave with your husband or wife 10. Be consistent with your instructor WRITE THE KOREAN NUMBERS (1 point each = 10 points) One Two Three Four Five Six Seven Eight Nine Ten MATCHING (3 points each = 30 points) 1. Form Ahp Cha Gee 2. Attention Chah Ryuht 3. Ready Motion Doe Rah 4. Block Joon Bee 5. Knife Hand Ki Mah Jah Seh 6. Turn Around Kyung Nieh 7. Bow Mahk Gee 8. Front Kick Poom Seh 9. Side Kick Soo Do 10. Horse Riding Stance Yup Cha Gee WRITE THE MEANING (4 points each = 20 points) 1. Taekwondo 2. Moo Do 3. Doe Bok 4. Een Nae 5. Gam Sah Hap Mee Dah Instructor s Full Name and Rank (5 points) National Origin of TaeKwonDo (5 points)

3 Y.C. Kim Black Belt Society YELLOW to ORANGE Belt Size Student s Name Date of Birth / / Age Address City Zip Home Phone Cell Phone School Beavercreek South Community YMCA If at any time I violate any of the following three (3) rules and regulations governing the Y.C. KIM BLACK BELT SOCIETY, I hereby agree that the organization reserves the right to suspend my rank or status. 1. The purpose of Taekwondo is to improve both mental and physical health and all members must uphold and protect the honor and prestige of Taekwondo. 2. Members are forbidden to use Taekwondo techniques to provoke and challenge innocent persons; and such use will make offending members subject to disciplinary action. 3. The Y.C. KIM BLACK BELT SOCIETY is the sole judge of my qualifications and achievements in this Martial Art. I agree that the promotion examination fee which has been paid is not refundable under any circumstances and also that I will accept any grade or belt rendered by this college with complete satisfaction, neither demanding nor protesting for a higher belt or grade. OFFICE USE ONLY: Total Fee paid: Circle one: Cash Check # Received by: Date Forms Palgue 1 Taeguk 1 Step Sparring (2 step) Step Sparring 1 Step Sparring 2 Step Sparring 3 Step Sparring 4 Step Sparring 5 Technique/Spirit Back-Spinning Side Kick Other Attitude/Class OVERALL COMMENTS: Pass Conditional Retest Grade Examinerʼs Signature

4 KIM'S TAEKWONDO COLLEGE SCORE: /100 PROMOTION EXAMINATION - Yellow to Orange Belt Scored by: (Age 12 and under may take home) NAME: AGE: DATE: BRANCH: MATCHING (3 points each = 30 points) 1. Be loyal with brothers and sisters 2. Be obedient never retreating in battle 3. Be lovable with your elders 4. Be cooperative with the use of Taekwondo using, it justly 5. Be respectful to your parents 6. Be faithful always finishing what you start 7. Be honorable to your country 8. Be discrete with your instructor 9. Be brave with your friends 10. Be consistent with your husband or wife WRITE THE MEANING (4 points each = 20 points) 1. Taekwondo 2. Moo Do 3. Doe Jahng 4. Een Nae 5. Gam Sah Hap Mee Dah GIVE THE KOREAN NAME (2 points each = 20 points) 1. Basic Technique 6. Two Step Sparring 2. Sparring Motion 7. Skip Side Kick 3. Knife Hand Attack 8. Round House Kick 4. Technique 9. Back Spinning Side Kick 5. Uniform 10. Block GIVE THE KOREAN NAME FOR THE FORMS REQUIRED OF YELLOW BELTS (5pts each = 10pts) WRITE THE KOREAN NUMBERS (2 points each = 20 points) One Five Nine Two Six Ten Three Seven Four Eight INSTRUCTOR'S FULL NAME AND TITLE (10 pts)

5 Y.C. Kim Black Belt Society ORANGE to LIGHT BLUE Belt Size Student s Name Date of Birth / / Age Address City Zip Home Phone Cell Phone School Beavercreek South Community YMCA If at any time I violate any of the following three (3) rules and regulations governing the Y.C. KIM BLACK BELT SOCIETY, I hereby agree that the organization reserves the right to suspend my rank or status. 1. The purpose of Taekwondo is to improve both mental and physical health and all members must uphold and protect the honor and prestige of Taekwondo. 2. Members are forbidden to use Taekwondo techniques to provoke and challenge innocent persons; and such use will make offending members subject to disciplinary action. 3. The Y.C. KIM BLACK BELT SOCIETY is the sole judge of my qualifications and achievements in this Martial Art. I agree that the promotion examination fee which has been paid is not refundable under any circumstances and also that I will accept any grade or belt rendered by this college with complete satisfaction, neither demanding nor protesting for a higher belt or grade. OFFICE USE ONLY: Total Fee paid: Circle one: Cash Check # Received by: Date Forms Palgue 2 Taeguk 2 Step Sparring (1 step) Step Sparring 1 Step Sparring 2 Step Sparring 3 Step Sparring 4 Step Sparring 5 Technique/Spirit Roundhouse Kick Other Attitude/Class OVERALL COMMENTS: Pass Conditional Retest Grade Examinerʼs Signature

6 KIM'S TAEKWONDO COLLEGE SCORE: /100 PROMOTION EXAMINATION - Orange to Lt. Blue Belt Scored by: (Age 12 and under may take home) NAME: AGE: DATE: BRANCH: MATCHING (3 points each = 30 points) 1. Be loyal with brothers and sisters 2. Be obedient never retreating in battle 3. Be lovable with your elders 4. Be cooperative with the use of Taekwondo using, it justly 5. Be respectful to your parents 6. Be faithful always finishing what you start 7. Be honorable to your country 8. Be discrete with your instructor 9. Be brave with your friends 10. Be consistent with your husband or wife MATCH (2 points each = 10 points) 1. Basic Technique Hoe Shin Sool 2. Form Kyuhk Pah 3. One Step Sparring Ki Bon Don Jahk 4. Self Defense Poom Seh 5. Il Bo Dae Ryuhn WRITE THE MEANING (2 points each = 10 points) 1. Taekwondo 2. Moo Do 3. Doe Bok 4. Doe Jahng 5. Een Nae GIVE THE KOREAN NAME (1 point each = 10 points) 1. Spear Hand Attack 6.SkipSideKick 2. Sparring Motion 7. Jump Front Kick 3. Jump Side Kick 8. Skip Round House Kick 4. Technique 9. Front Spinning Side Kick 5. Patience and Perseverance 10. Thank you very much GIVE THE KOREAN NAME OF THE FORMS REQUIRED OF ORANGE BELTS (5 points each = 10 points) INSTRUCTOR'S FULL NAME AND TITLE (10 points) TRUE OR FALSE (WRITE "T" OR "F") (2 points each = 20 points) Doe Bok means "Training Hall" Palgue 2 follows the same pattern as Palgue 1 Master Kim has modified some Tae Gook stances In competition sparring, I earn 1 point if I can successfully punch to the face The referee's main job is to control the competition As an Orange Belt, I should know 7 forms A round house kick used for sparring and for breaking are performed the same way Karate is a Korean martial art Taekwondo is both a martial art and a sport

7 Y.C. Kim Black Belt Society LIGHT BLUE to GREEN Belt Size Student s Name Date of Birth / / Age Address City Zip Home Phone Cell Phone School Beavercreek South Community YMCA If at any time I violate any of the following three (3) rules and regulations governing the Y.C. KIM BLACK BELT SOCIETY, I hereby agree that the organization reserves the right to suspend my rank or status. 1. The purpose of Taekwondo is to improve both mental and physical health and all members must uphold and protect the honor and prestige of Taekwondo. 2. Members are forbidden to use Taekwondo techniques to provoke and challenge innocent persons; and such use will make offending members subject to disciplinary action. 3. The Y.C. KIM BLACK BELT SOCIETY is the sole judge of my qualifications and achievements in this Martial Art. I agree that the promotion examination fee which has been paid is not refundable under any circumstances and also that I will accept any grade or belt rendered by this college with complete satisfaction, neither demanding nor protesting for a higher belt or grade. OFFICE USE ONLY: Total Fee paid: Circle one: Cash Check # Received by: Date Forms Palgue 3 Taeguk 3 Pyong-An 1 Step Sparring (1 step) Step Sparring 1 Step Sparring 2 Step Sparring 3 Step Sparring 4 Step Sparring 5 Technique/Spirit Jump Side Kick Other Attitude/Class OVERALL COMMENTS: Pass Conditional Retest Grade Examinerʼs Signature

8 Y.C. Kim Black Belt Society LIGHT BLUE to GREEN Score /100 Scored by: Student s Name Age Date / / MATCHING (2 points each = 20 points) 1. Be loyal always finishing what you start 2. Be obedient never retreating in battle 3. Be lovable to your country 4. Be cooperative to your parents 5. Be respectful with brothers and sisters 6. Be faithful with the use of Taekwondo, using it justly 7. Be honorable with your elders 8. Be discrete with your friends 9. Be brave with your husband or wife 10. Be consistent with your instructor WRITE THE MEANING (2 points each = 10 points) 1. Dwee Ahp Cha Gee 2. Dwee Dol Yut Cha Gee 3. Moo Do 4. Son Bah Dahk Kong Kyuhk 5. Yark Sok Dae Ryuhn MATCHING (2 points each = 20 points) 1. Basic Technique Hoe Shin Sool 2. Form Il Bo Dae Ryuhn 3. One Step Sparring Ki Bon Don Jahk 4. Self Defense Kyuhk Pah 5. Poom Seh WRITE THE KOREAN TERM (2 points each = 10 points) Basic Technique Technique Front Stretching Kick Patience and Perseverance Sparring Motion TRUE OR FALSE (WRITE "T" OR "F") (2 points each = 20 points) Doe Bok means "Training Hall" Master Kim has modified some Tae Gook stances In competition sparring, I earn 1 point if I attack a fallen opponent The referee's main job is to control the competition Round house kicks used for sparring and for breaking are performed the same way All reverse motions are performed with the shoulders square to focus Taekwondo is primarily a sport In competition sparring, a warning causes the player to loose a full point Official competitions for our organization are sanctioned by the PKA Official competition colors are Red and Black GIVE THE KOREAN NAME OF YOUR REQUIRED FORMS (5 points each = 15 points) Instructor s Full Name and Rank (5 points)

9 Y.C. Kim Black Belt Society GREEN to PURPLE Belt Size Student s Name Date of Birth / / Age Address City Zip Home Phone Cell Phone School Beavercreek South Community YMCA If at any time I violate any of the following three (3) rules and regulations governing the Y.C. KIM BLACK BELT SOCIETY, I hereby agree that the organization reserves the right to suspend my rank or status. 1. The purpose of Taekwondo is to improve both mental and physical health and all members must uphold and protect the honor and prestige of Taekwondo. 2. Members are forbidden to use Taekwondo techniques to provoke and challenge innocent persons; and such use will make offending members subject to disciplinary action. 3. The Y.C. KIM BLACK BELT SOCIETY is the sole judge of my qualifications and achievements in this Martial Art. I agree that the promotion examination fee which has been paid is not refundable under any circumstances and also that I will accept any grade or belt rendered by this college with complete satisfaction, neither demanding nor protesting for a higher belt or grade. OFFICE USE ONLY: Total Fee paid: Circle one: Cash Check # Received by: Date Forms Palgue 4 Taeguk 4 Pyong-An 2 Optional Form(s) Step Sparring (1 step) Step Sparring 1 Step Sparring 2 Step Sparring 3 Step Sparring 4 Step Sparring 5 Technique/Spirit Jump Back- Spinning Side Kick Other Attitude/Class Pass Conditional Retest OVERALL COMMENTS: Grade Examinerʼs Signature

10 KIM'S TAEKWONDO COLLEGE SCORE: /100 PROMOTION EXAMINATION - Green to Purple Belt Scored by: (Age 12 and under may take home) NAME: AGE: DATE: BRANCH: WRITE THE STUDENT CREED (3 points each = 30 points) MATCH (5 points each = 40 points) 1. Basic Technique Il Bo Dae Ryuhn 2. High Reverse Round House Kick Ki Bon Don Jahk 3. Modified Round House Kick Poom Seh 4. Forms Yark Sok Dae Ryuhn 5. One Step Sparring Kyuhk Pah 6. Self Defense Technique Byon Huyung Dol Yut Cha Gee 7. Semi-sparring Technique Sahng Dahn Yehrk Dol Yut Cha Gee 8. Technique Hoe Shin Sool NAME THE SEQUENCE OF COLORED RANK BELTS FROM WHITE TO BLACK (2 points each = 20 points) GIVE THE KOREAN NAME OF THE FORMS REQUIRED OF GREEN BELTS (5 points each = 10 points) 1. 2.

11 Y.C. Kim Black Belt Society PURPLE to BROWN Belt Size Student s Name Date of Birth / / Age Address City Zip Home Phone Cell Phone School Beavercreek South Community YMCA If at any time I violate any of the following three (3) rules and regulations governing the Y.C. KIM BLACK BELT SOCIETY, I hereby agree that the organization reserves the right to suspend my rank or status. 1. The purpose of Taekwondo is to improve both mental and physical health and all members must uphold and protect the honor and prestige of Taekwondo. 2. Members are forbidden to use Taekwondo techniques to provoke and challenge innocent persons; and such use will make offending members subject to disciplinary action. 3. The Y.C. KIM BLACK BELT SOCIETY is the sole judge of my qualifications and achievements in this Martial Art. I agree that the promotion examination fee which has been paid is not refundable under any circumstances and also that I will accept any grade or belt rendered by this college with complete satisfaction, neither demanding nor protesting for a higher belt or grade. OFFICE USE ONLY: Total Fee paid: Circle one: Cash Check # Received by: Date Forms Palgue 5 Taeguk 5 Pyong-An 3 Optional Form(s) Step Sparring (2 block) Step Sparring 1 Step Sparring 2 Step Sparring 3 Step Sparring 4 Step Sparring 5 Technique/Spirit Jump Front Kick Other Attitude/Class OVERALL COMMENTS: Pass Conditional Retest Grade Examinerʼs Signature

12 KIM'S TAEKWONDO COLLEGE SCORE: /100 PROMOTION EXAMINATION - Purple to Brown Belt Scored by: (Age 12 and under may take home) NAME: AGE: DATE: BRANCH: WRITE THE STUDENT CREED (3 points each = 30 points) MATCH (5 points each = 40 points) 1. Low Palm Block Kyuhk Pah 2. Elbow Attack Poom Seh 3. Forms Hoe Shin Sool 4. Jump Back Spinning Side Kick Phal Goop Kyonk Kyuhk 5. Jump Front Spinning Side Kick Yark Sok Dae Ryuhn 6. Self Defense Technique Hah Dahn Son Bah Dak Mahk Gee 7. Semi-sparring Technique Yi Dahn Dwee Yup Cha Gee 8. Technique Yi Dayn Ahp Dol Yut Yup Cha Gee FILL IN THE BLANK (3 points each = 30 points) 1. Taekwondo practitioners bow as an expression of. 2. The name of the yell that is done with final techniques is. 3. The technical name for "middle target" is. 4. The target for an "upper punch" is. 5. A front snap kick contacts a target with the of the foot. 6. A side snap kick contacts a target with the edge of the. 7. The letters which stand for the World Taekwondo Federation are. 8. Name 4 basic Taekwondo stances:,,,. 9. The seated position to help a student clear his mind and to relax is known as position. 10. When in a forward stance, the front knee must be, the back leg must be.

13 Y.C. Kim Black Belt Society BROWN to RED Belt Size Student s Name Date of Birth / / Age Address City Zip Home Phone Cell Phone School Beavercreek South Community YMCA If at any time I violate any of the following three (3) rules and regulations governing the Y.C. KIM BLACK BELT SOCIETY, I hereby agree that the organization reserves the right to suspend my rank or status. 1. The purpose of Taekwondo is to improve both mental and physical health and all members must uphold and protect the honor and prestige of Taekwondo. 2. Members are forbidden to use Taekwondo techniques to provoke and challenge innocent persons; and such use will make offending members subject to disciplinary action. 3. The Y.C. KIM BLACK BELT SOCIETY is the sole judge of my qualifications and achievements in this Martial Art. I agree that the promotion examination fee which has been paid is not refundable under any circumstances and also that I will accept any grade or belt rendered by this college with complete satisfaction, neither demanding nor protesting for a higher belt or grade. OFFICE USE ONLY: Total Fee paid: Circle one: Cash Check # Received by: Date Forms Palgue 6 Taeguk 6 Pyong-An 4 Optional Form(s) Step Sparring (Kneeling) Step Sparring 1 Step Sparring 2 Step Sparring 3 Step Sparring 4 Step Sparring 5 Technique/Spirit Wheel Kick Other Attitude/Class Assistant Teaching Quantity Quality OVERALL COMMENTS: Pass Conditional Retest Grade Examinerʼs Signature

14 KIM'S TAEKWONDO COLLEGE SCORE: /100 PROMOTION EXAMINATION - Brown to Red Belt Scored by: (Age 12 and under may take home) NAME: AGE: DATE: BRANCH: MATCH (2.5 points each = 25 points) 1. Low Block Ahp 2. High Block Hah Dahn Mahk Gee 3. Side Block Kwan Soo 4. Knife Hand Kap Kwon 5. Middle Punch Sahng Dahn Mahk Gee 6. Spear Hand Soo Do 7. Back Fist Yup Mahk Gee 8. Elbow Joong Dahn Kong Kyuhk 9. Attack Phal Goop 10. Front Kong Kyuhk MATCH (2.5 points each = 25 points) 1. Side Yi Dahn Yup Cha Gee 2. Middle Ahp Cha Gee 3. Forward Stance Dol Yut Cha Gee 4. Horse Riding Stance Dwi Yup Cha Gee 5. Front Kick Joong Dahn 6. Side Kick Yup 7. Round House Kick Ki Mah Jah Seh 8. Back Spinning Side Kick Chuhn Gool Jah Seh 9. Jump Side Kick Yup Cha Gee 10. Back Stance Hoo Gool Jah Seh MATCH (2.5 points each = 25 points) 1. Palgue 6 Hoe Shin Sool 2. Wheel Kick Gam Sah Hap Mee Day 3. Patience and Perseverance Ki Bon Dong Jahk 4. Training Hall (Temple) Muk Ryum 5. Thank You Very Much Wheh Chun Cha Gee 6. Martial Art Ki Hap 7. Meditation Do Jahng 8. Sound of power (yell) Een Nae 9. Basic Technique Palgue Yuk Chang 10. Self Defense Moo Do MATCH (2.5 points each = 25 points) 1. Kyung Nieh 2. Sparring Kukkiwon 3. One Step Sparring Seoul 4. Um Yang Symbol Kyuhk Pah 5. WTF Headquarters Dae Ryuhn 6. Capital of Korea Chah Ryuht 7. Ready Motion Il Bo Dqe Ryuhn 8. Attention Joon Bee 9. Bow Ki Cho Sahm Bo 10. Basic Form 3 Tae Gook

15 Y.C. Kim Black Belt Society RED to NAVY BLUE Belt Size Student s Name Date of Birth / / Age Address City Zip Home Phone Cell Phone School Beavercreek South Community YMCA If at any time I violate any of the following three (3) rules and regulations governing the Y.C. KIM BLACK BELT SOCIETY, I hereby agree that the organization reserves the right to suspend my rank or status. 1. The purpose of Taekwondo is to improve both mental and physical health and all members must uphold and protect the honor and prestige of Taekwondo. 2. Members are forbidden to use Taekwondo techniques to provoke and challenge innocent persons; and such use will make offending members subject to disciplinary action. 3. The Y.C. KIM BLACK BELT SOCIETY is the sole judge of my qualifications and achievements in this Martial Art. I agree that the promotion examination fee which has been paid is not refundable under any circumstances and also that I will accept any grade or belt rendered by this college with complete satisfaction, neither demanding nor protesting for a higher belt or grade. OFFICE USE ONLY: Total Fee paid: Circle one: Cash Check # Received by: Date Forms Palgue 7 Taeguk 7 Pyong-An 5 Optional Form(s) Step Sparring (Knife) Step Sparring 1 Step Sparring 2 Step Sparring 3 Step Sparring 4 Step Sparring 5 Technique/Spirit Wheel Kick/Hand Other Attitude/Class Assistant Teaching Quantity Quality OVERALL COMMENTS: Pass Conditional Retest Grade Examinerʼs Signature

16 KIM'S TAEKWONDO COLLEGE SCORE: /100 PROMOTION EXAMINATION - Red to Navy Belt Scored by: (Age 12 and under may take home) NAME: DATE: BRANCH: AGE: MATCHING (3 points each = 75 points) 1. Basic Technique Ahp Mahk Gee 2. Knife Hand Low Block Een Nae 3. Knife Hand Middle Block Doe Jahng 4. Front Snap Kick Sahng Soo Joong Dahn Yup Mahk Gee 5. Forward Middle Block Dwi Yehrk Soo Do Ahp Mahk Gee 6. Upper Block Doe Bok 7. Side Snap Kick Ki Bon Dong Jahk 8. Low Block Dol Yut Cha Gee 9. Reverse Knife Hand Forward Mid Block Yi Dahn Dwi Wheh Chun Cha Gee 10. Double Middle Side Block Il Bo Dae Ryuhn 11. Forward Middle Punch Dwi Yehrk Joong Dahn Kong Kyuhk 12. Reverse Middle Punch Hah Dahn Mahk Gee 13. Back Spinning Wheel Kick Gam Sah Hap Mee Dah 14. Jump Back Spinning Wheel Kick Soo Do Joong Dahn Mahk Gee 15. One Step Sparring Ahp Kong Kyuhk 16. Self Defense Technique Yark Sok Dae Ryuhn 17. Semi-Sparring Technique Sahm Dahn Mahk Gee 18. Technique Hoe Shin Sool 19. Martial Art Uniform Moo Doe 20. Training Hall Soo Do Hah Dahn Mahk Gee 21. Martial Art Yup Cha Gee 22. Round House Kick Poom Seh 23. Forms Ahp Cha Gee 24. Patience and Perseverance Dwi Whwh Chaun Cha Gee 25. Thank You Very Much Kyuhk Pah NAME THE 2 FORMS REQUIRED OF RED BELTS (4 points each = 8 points) GIVE THE FULL NAME AND RANK OF YOUR MASTER INSTRUCTOR (5 points) At what rank is a Taekwondoist considered a Master? (2pts) At what rank is a Master considered a Grand Master? (2pts) What do the following letters stand for? (2 points each = 8pts) WTF IOC USTU USOC

17 BLACK BELT PRE-TEST Y.C. KIM TAEKWONDO COLLEGE BLACK BELT SOCIETY STUDENT'S NAME DATE OF BIRTH AGE ADDRESS street city zip PHONE NUMBER OCCUPATION BRANCH SCHOOL INSTRUCTOR Basic Form Comments: Pyong Ann Comments: Basai A Comments:

18 Palgue Comments: Taegook Comments:

19 NAVY BLUE - BLACK Y.C. KIM TAEKWONDO COLLEGE BELT SIZE BLACK BELT SOCIETY STUDENT'S NAME DATE OF BIRTH AGE ADDRESS street city zip PHONE NUMBER OCCUPATION BRANCH SCHOOL INSTRUCTOR If at any time I violate any of the following three (3) rules and regulations governing the Y.C. KIM TAEKWONDO COLLEGE, I hereby agree that the organization reserves the right to suspend my rank or status. 1. The purpose of Taekwondo is to improve both mental and physical health and all members must uphold and protect the honor and prestige of Taekwondo. 2. Members are forbidden to use Taekwondo techniques to provoke and challenge innocent persons; and such use will make offending members subject to disciplinary action. 3. That the Y.C. KIM TAEKWONDO COLLEGE, is the sole judge of my qualifications and achievements in this Martial Art. I agree that the promotion examination fee which has been paid is not refundable under any circumstances and also that I will accept any grade or belt rendered by this college with complete satisfaction, neither demanding nor protesting for a higher belt or grade. OFFICE USE ONLY: Total fee paid: Received by: Date Circle one: Cash Check # Basic Form Basai A Palgue Taegook Pyong Ann Step Sparring Martial Arts Attitude Cleanliness Assistant Teaching - Qty. Assistant Teaching - Qual. EXAMINER'S SIGNATURE AVG. TOTAL PTS GRADE

20 1 st DAN - 2 nd DAN Y.C. KIM TAEKWONDO COLLEGE BELT SIZE BLACK BELT SOCIETY STUDENT'S NAME DATE OF BIRTH AGE ADDRESS street city zip PHONE NUMBER OCCUPATION BRANCH SCHOOL INSTRUCTOR If at any time I violate any of the following three (3) rules and regulations governing the Y.C. KIM TAEKWONDO COLLEGE, I hereby agree that the organization reserves the right to suspend my rank or status. 1. The purpose of Taekwondo is to improve both mental and physical health and all members must uphold and protect the honor and prestige of Taekwondo. 2. Members are forbidden to use Taekwondo techniques to provoke and challenge innocent persons; and such use will make offending members subject to disciplinary action. 3. That the Y.C. KIM TAEKWONDO COLLEGE, is the sole judge of my qualifications and achievements in this Martial Art. I agree that the promotion examination fee which has been paid is not refundable under any circumstances and also that I will accept any grade or belt rendered by this college with complete satisfaction, neither demanding nor protesting for a higher belt or grade. OFFICE USE ONLY: Total fee paid: Received by: Date Circle one: Cash Check # Forms Basai A Basai B Gin To A Gin To B Koryo Step Sparring Martial Arts Attitude Cleanliness Assistant Teaching - Qty. Assistant Teaching - Qual. OVERALL COMMENTS: EXAMINER'S SIGNATURE AVG. TOTAL PTS GRADE

21 2 nd DAN - 3 rd DAN Y.C. KIM TAEKWONDO COLLEGE BELT SIZE BLACK BELT SOCIETY STUDENT'S NAME DATE OF BIRTH AGE ADDRESS street city zip PHONE NUMBER OCCUPATION BRANCH SCHOOL INSTRUCTOR If at any time I violate any of the following three (3) rules and regulations governing the Y.C. KIM TAEKWONDO COLLEGE, I hereby agree that the organization reserves the right to suspend my rank or status. 1. The purpose of Taekwondo is to improve both mental and physical health and all members must uphold and protect the honor and prestige of Taekwondo. 2. Members are forbidden to use Taekwondo techniques to provoke and challenge innocent persons; and such use will make offending members subject to disciplinary action. 3. That the Y.C. KIM TAEKWONDO COLLEGE, is the sole judge of my qualifications and achievements in this Martial Art. I agree that the promotion examination fee which has been paid is not refundable under any circumstances and also that I will accept any grade or belt rendered by this college with complete satisfaction, neither demanding nor protesting for a higher belt or grade. OFFICE USE ONLY: Total fee paid: Received by: Date Circle one: Cash Check # Forms Basai A Basai B Gin To A Gin To B Koryo Gong San Gun Si Sun Gum Kang Step Sparring Martial Arts Attitude Cleanliness Assistant Teaching - Qty. Assistant Teaching - Qual. OVERALL COMMENTS: EXAMINER'S SIGNATURE AVG. TOTAL PTS GRADE