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Student First Name

Student Last Name

Birtdate

Gender

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Full Name (How you want it to appear on Diploma ex – John P. Smith)

Facility

Address

City	State	Zip

Phone

Email Address

How Did You Find Us?

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Emergency Contact Name

Emergency Phone

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List any Medical Conditions

Please fill out information below if student is a minor.

Mother/Guardian First Name

Mother/Guardian Last Name

Mother/Guardian Phone (if different)

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Father/Guardian First Name

Father/Guardian Last Name

Father/Guardian Phone (if different)

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Online Exams – Required

Students must have the Pre-Karate or regular Karate textbooks in order to take the above tests. Answers are in the back of the books. Books must be purchased from your karate instructor.
Take the online test for the belt you are testing for – not the belt you currently have.
Make sure to click “Submit Results” once you receive a 100% on the test – otherwise your test will not be credited.

Pre-Karate (4-5 year olds)First Name:

Last Name:

Belt Rank:

Select TestWhite/YellowWhite/OrangeWhite/PurpleWhite/BlueWhite/GreenWhite/Brown

Karate (6 years old thru adults)First Name:

Last Name:

Belt Rank:

Written Exams

Black Belt Exam

The black belt exam in an in class exam that must be completed before taking the practical portion of black belt test. Students are required to complete the exam in one and a half hours scoring 100%.

Download Practice Exam