Turn in Forms to Front Desk
Family Martial Arts Center
Red/Red-1/Red-Black Belt Testing Form (Rotation 3)
FILLED OUT BY STUDENT
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Name
Phone Number
Age
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Testing Date
# of Classes
Belt Size
Masters Club (Y/N)
Black Belt Club (Y/N)
Red/Red-1/Red-Black Belt Martial Arts Doctrine (Rotation 3)
Answered by the Student
1. Explain the concept of Praise-Correct-Praise: ___________________________________________________________________
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2. What does it mean to be a leader?_________________________________________________________________________
3. What is the 7th Habit of Highly Successful People and What does it mean?____________________________________________________
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Kicking/Breaking (Black Stripe)
1. Board Breaking - 360 Back Kick
Grade
Comments
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Forms/Basics (Blue Stripe)
1. Yuk Jang
2. Chil Jang
Defense (White Stripe)
1. Control Mount
2. Escape Mount
3. Cross Wrist Choke
4. Arm Bar from Mount
5. Wrist Grab
6. Rear Bear Hug
Sparring (Red Stripe)
1. Sparring Essentials
Hands Up
Footwork
Comboniations
Kickboxing (Gold Stripe)
1. CAMA Combo Section #1
Weapons Basics - BBT Only (Green Stripe)
1. 4 Count
EXPLANATION OF GRADES
A - Excellent B - Above Average C - Average RT - Retest
Family Martial Arts Center
Belt Promotion - Home/School Evaluation
Dear Parents and Teachers:
Our main objective at Family Martial Arts is develop well rounded students, not only at our school, but in society as
well. Our school teaches the principles of Black Belt Excellence. Not only do students become Black Belts in martial
arts, but they also strive to become academic Black Belts and eventually develop an attitude of constant achievement.
We use Black Belt as a metaphor for personal excellence.
In order to promote our students' progress toward these goals, we respectfully request you complete the following form.
Student's Name:________________________________
Belt Rank: ____________________________
Parent's Evaluation
My child's behavior at home has been congruent with that of the principles of Black Belt Excellence: courtesy, respect,
discipline, self-control, focus, etc.
Yes _______
No _______
My child practices his/her martial arts at home.
Yes _______
No _______
I have questions/concerns. The most convenient time to reach me is: ____________________________
Please call me.
Yes _______
No _______
Please provide a brief "Letter of Recommendation" below, expanding on your child's behavior both at home and at school.
___________________________________________________________________________________________________
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Parent's Signature: ____________________________________
Date: ________________________
Teacher's Evaluation
Teacher's Name: ____________________________
School Name/Grade: _____________________________
_____________________________________ has been doing satisfactory work in my class and is receiving good
grades while being respectful to teachers and other students.
Yes _______
No _______
Circle One: I am/I am not interested in having your martial arts school to do a talk or demonstration for my class.
Phone Number: _____________________________
Convenient Time to Call: _________________________________
E-mail: ______________________________
Signature: ___________________________________________
If our students do not meet any of these qualifications, either at home, school or at Family Martial Arts, we will hold
the student's promotion until there has been satisfactory improvement. If you have any direct feedback beyond the scope
of this form, please feel free to write on a separate piece of paper or call me directly at (303) 699-1800.
Chris Natzke
Master Instructor
Student Referral
The following friend(s) are interested in taking martial arts lessons. Please contact them and invite them as my guest.
Name: ______________________________________
Address: ____________________________________
City: _______________________________________
Phone Number: (_____) _______-_________