Ernie Reyes' West Coast World Martial Arts Association BLUE BELT TEST Rev. 1/22/2018 FILLED OUT BY STUDENT ______Name Branch Location Age Belt Size IMPORTANT: PLEASE SIGN BACK

REQUIREMENT CHECKLIST Membership Card Received all Stripes All Patches on Uniform (Association) $40 Testing Fee Received Instructor's Approval $55 Late Fee received (after due date) ______Judged By Date Application Due Received By Date

EXPLANATION OF GRADES (E) = Excellent (+) = Passing (P) = Possibility ( RT) = Retest GRADE COMMENTS FORMS / BASICS (Stripe-7) 1. 1/2 of Palgae-2 ______KICKING TECHNIQUES (Stripe-6) JUMP KICK NOT NECESSARY DUE TO CERTAIN CIRCUMSTANCES OR ADULTS! 1. Slide round kick, rear leg round kick, slide round kick, rear leg round kick, back kick, double ______2. Slide side kick, back kick, rear leg instep round house kick, back kick, pop up side kick ______3. Running: Jump front/side/round kick ____ /____ /______4. Pop up front/side kick ____ /______5. Slide side kick ______WRIST RELEASES SELF DEFENSE (Stripe-5) Wrist Release 1. Release ______Self Defense 1. 5-Swords ______2. Review - Self Defense Techniques #1 - #5 ______SPARRING TECHNIQUES FIGHTING SYSTEM (Stripe-4) 1. Breaking Timing & 1/4 Turns ______2. Fighting System 1) Take Downs ______2) Do Straight punches, punches, , Evading round house kicks, & Clinch techniques ______3. Free Sparring ______Use all Fighting System Techniques learned to date BASIC MMA TECHNIQUES (Stripe-3)

1. O ense - Striking when on - Top of Side Position ______2. Defense - Defending when in - Bottom of Side Position ______

STICKS (Stripe-2) 1. 1 - 7 Strikes ______2. 1 - 5 Blocks ______3. Single Sinawali (1 stick) ______ADULT ONLY STICK TRAINING 1. 1 - 12 Block and Counter ______2. Single Sinawali (1 stick) ______

Ernie Reyes' West Coast World Martial Arts Association Ernie Reyes' West Coast World Martial Arts PAD WORK BLUE BELT TEST CONTINUED KICK PATTERN (Stripe-1) Rev. 1/22/2018 1. Count #6 - Bob and weave to right, right , left hook straight right ______Count #7 - Head clinch, Right knee, step left knee ______Count #8 - Right upper elbow, left upper elbow ______Count #9 - Right round kick, cross step left round kick ______2. Do Count #1 to #9 ______

MARTIAL ARTS DOCTRINE 1. What does Giving Value mean?______

2. What is State Management? ______

3. What has Martial Arts taught you up to now?______

PARENT / GUARDIAN APPROVAL (Required for all students under 18 years of age) DEAR PARENT, GUARDIANS, AND TEACHERS, Our main objective at Ernie Reyes' West Coast World Martial Arts is to develop Black Belts, not only in martial arts, but in life as well. This means striving for their best in everything they do in life. The following approval enables us to work with our students in attaining these goals.

PARENTS / GUARDIANS: 1. My child has been cooperating and behaving at home. Yes _____ No _____ 2. My child has been showing respect to Parents / Guardians, brothers and/or sisters (if any) Yes _____ No _____ 3. My child has been keeping up with their responsibilities at home. Yes _____ No _____

Parent's Signature ______Comments: ______If more than 1 teacher, each must sign this form (use Comments section if necessary) TEACHERS: 1. My student has been doing satisfactory or above schoolwork. Yes _____ No _____ 2. My student is being a good citizen at school. Yes _____ No _____ 3. My student has been showing satisfactory or above e ort in the classroom. Yes _____ No _____

Teacher's Signature ______Comments:______

If the student does not meet all of the above quali cations, we will hold the student promotion until there has been satisfactory improvement. If you have any direct feedback beyond the scope of this form, please feel free to write it on a seperate piece of paper. Thank you for your cooperation.

P. S. WE ARE AVAILABLE FOR SAFETY SCHOOL PRESENTATIONS! In the past, we have had positive responses to our classroom appearances and have several teachers references as testimonials. This is an opportunity for us to communicate the importance of safety and demonstrate the mental benets of focus, self-control, respect, and self-defense to your entire class. If this sounds like something in which you are interested in, please ll out the following information.

Student's Name: ______Teacher's Name: ______

School Name: ______Room Number: ______Number of Students: ______PAD WORK: (Stripe-1) Contact Number: ______Best Time To Call: ______E-mail: ______

FILLED OUT BY STUDENT OR PARENT I do hereby arm and say, that I apply for the rank of BLUE 1 BELT. That Ernie Reyes' West Coast World Martial Arts is not responsible for any accident which may occur during this test. I accept the results given to me.

Signature (parent if under18)