6-BLUE BELT FRONT.ai - West Coast World Martial Arts Berryessa

Ernie Reyes' West Coast World Martial Arts Association
BLUE BELT TEST
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)
1. Slide round kick, rear leg round kick, slide
round kick, rear leg round kick, back kick,
double punch _________ ________________________
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 ____ /____ _________________________
WRIST RELEASES
SELF DEFENSE (Stripe-5)
FILLED OUT BY STUDENT
_______________________________ _________________________ __________ __________
Name Branch Location Age Belt Size
IMPORTANT: PLEASE SIGN BACK
Membership Card
All Patches on Uniform (Association)
Instructor's Approval
REQUIREMENT CHECKLIST
Received all Stripes
$30 Testing Fee Received
$45 Late Fee received (after due date)
_____________________________ ________________________ _______________ __________
Judged By Date Application Due Received By Date
JUMP KICK NOT NECESSARY DUE TO CERTAIN CIRCUMSTANCES OR ADULTS!
Wrist Release
1. Release _________ _________________________
SPARRING TECHNIQUES
FIGHTING SYSTEM (Stripe-4)
1. Breaking Timing & 1/4 Turns _________ _________________________
2. Fighting System
1) Take Downs _________ _________________________
2) Do Straight punches, Hook punches, Uppercuts,
Evading round house kicks, & Clinch techniques _________ _________________________
3. Free Sparring _________ _________________________
Use all Fighting System Techniques learned to date
BASIC MMA TECHNIQUES (Stripe-3)
1. Offense - 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 Rev A 9/1/2010
Rev. 9/1/2010
Self Defense
1. 5-Swords _________ _________________________
2. Review - Self Defense Techniques #1 - #5 _________ _________________________

PAD WORK
KICK BOXING PATTERN (Stripe-1)
1. Count #6 - Bob and weave to right, right uppercut, left
hook straight right _________ ________________________
Count #7 - Head clinch, Right knee, cross 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 effort in the classroom. Yes _____ No _____
Teacher's Signature ___________________________
Comments:__________________________________________________________________________________________________
If the student does not meet all of the above qualifications, 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 he 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 benefits of focus, self-control, respect, and self-defense to your entire class.
If this sounds like something in which you are interested in, please fill 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 affirm 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)