Philippine Taekwondo Association Promo-Test-Application-Form

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PHILIPPINE TAEKWONDO ASSOCIATION

PROMOTION TEST APPLICATION FORM


Rizal Memorial Sports Complex, Manila, Philippines

The undersigned has completed all promotion test requirements and hereby attests that the information below
are true and correct.
Date of Present Examination Age Date of Birth

m m d d y y y y m m d d y y y y
First Name Citizenship / Nationality

Male Female
Middle Name Home Address

Last Name No. / Street

Chapter/Gym Bgy. / Subd.

Instructor City / Municipality

Province
Present Grade/Degree LEGEND :
(Please use the legend provided) W - Whitebelt 2nd B - Low Brown
Zip Code
8th Y - Low Yellow 1st B - High Brown
7th Y - High Yellow 1st Poom / Dan Mobile Number (Applicant)
6th B - Low Blue 2nd Poom / Dan
5th B - HIgh Blue 3rd Poom / Dan
4th R - Low Red 4th Dan (For Minors)
3rd R - HIgh Red 5th Dan
Mobile Number of Parent or Guardian
(For PTA Examiner's Use Only)
Form 1 2 3 4 5
WAIVER
Self-Defense 1 2 3 4 5 1. I will abide by the rules and regulations of the PTA
for this promotion test.
Kicking 1 2 3 4 5 2. I hold myself responsible for any injuries that I may
sustain during the test.
Free Sparring 1 2 3 4 5 3. I shall uphold the code of sportsmanship and shall
avoid inflicting any intentional or malicious harm
Basic Movements 1 2 3 4 5 against my opponent during the test.
4. I hereby permit PTA to send SMS & E-mail to us
Behavior & Conduct 1 2 3 4 5 (Only for SMART, Talk N' Text, Red Mobile Subscribers)

Breaking 1 2 3 4 5
Applicant's Signature Over Printed Name

Decision

Graded by: Approved by:


SUNG CHON HONG

PHILIPPINE TAEKWONDO ASSOCIATION


INFOBOARD

Name of Member:

Mobile Number:

Parent's Mobile Number (for minors): `


Classification:
Coach Referee Player Parent/Supporter TBB/TBS PTC
I allow PTA and SMART to send us SMS and E-mail (For Smart, Talk n Text, and Touch Mobile subscribers only).

Signature

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