Lewis Center Location Belt Testing Name* First Last Age* Current Belt Level:*-Please Select-White BeltYellow BeltGreen StripeOrange BeltGreen BeltBlue StripePurple BeltBlue BeltRed StripeBrown BeltRed BeltBlack StripeJr. PoomPoom Belt1st Degree1st Degree Level 11st Degree Level 21st Degree Level 31st Degree Level 41st Degree Level 51st Degree Level 61st Degree Level 72nd Degree2nd Degree Level 12nd Degree Level 22nd Degree Level 32nd Degree Level 42nd Degree Level 52nd Degree Level 62nd Degree Level 73rd Degree3rd Degree Level 13rd Degree Level 23rd Degree Level 33rd Degree Level 43rd Degree Level 53rd Degree Level 63rd Degree Level 7Testing Date* MM slash DD slash YYYY For STUDENT: What do you enjoy most about Tae Kwon Do?For STUDENT: What do you find most challenging about Tae Kwon Do?For STUDENT: What is your goal in Tae Kwon Do?For PARENTS: What areas of progress or challenge has your child experienced since last testing?Testing Fee Price: Testing Fee Price: Credit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20222023202420252026202720282029203020312032203320342035203620372038203920402041 Expiration Date Security Code Cardholder Name Total $0.00 Δ
