BELT TEST APPLICATION
The purpose of this information is to find out more about your son/daughter’s home and school habits. We strongly believe that the combination of good habits at our centre, your home and school are important parts of developing habits that can benefit his/her future.

Please fill out the following questionnaire.
Student Name *
Your answer
Age *
Your answer
Grading Date *
Testing Time *
Current Belt Level *
Testing for *
Does your son/daughter practice martial arts at home?
Does your son/daughter use martial arts inappropriately at home?
Do you or someone else help your son/daughter practice at home?
Would you like us to help coach your son/daughter better at home?
How would you describe your son/daughter’s listening skills?
Would you like to have a meeting with your son/daughter’s Instructor?
Please tell us how your son/daughter has improved since starting with us:
Your answer
Please tell us what your son/daughter needs to improve on:
Your answer
Deadline to Submit is the Wednesday before Grading Date
Testing Fee: $50.85 including HST

Cheques are to be made payable to Shields Prodigy Martial Arts Inc.

Cash, Debit, or Credit Card are also accepted.

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