Belt Testing Form Rank Examination Application Rank Examination Application Please submit this form as soon as possible and no later than 1 week prior to the scheduled testing date. We the testing board will attach this to your official testing form. Student First & Last Name: * Age: * Parent First & Last Name: * Present Rank (Belt Color): * I Will Attend * Regular Test Make-up Test I hereby wish to be tested for my next rank * Yes Program: * Karate Kids Basic Karate Kids BBC Beginner Intermediate Advanced Teen & Adult Black Belt Black Belts ONLY******* 1st Dan 2nd Dan 3rd Dan 4th Dan 1st Recertification 2nd Recertification 3rd Recertification 4th Recertification 5th Recertification 6th Recertification 7th Recertification By submitting this form I hereby authorize Encinitas Karate to charge the appropriate corresponding testing fee to the account on file. Taking the rank examination is not a guarantee to pass and will be determined by the testing board. Gup testing is $85, Black belt Recertification is $99, Black Belt Rank Changing test please see the front desk admin. Guardian/ Student Signature: * If you are human, leave this field blank. Submit
