PHILIPPINE TAEKWONDO ASSOCIATION

PROMOTION TEST APPLICATION FORM

Rizal Memorial Sports Complex, Manila, Philippines

The undersigned has completed all promo�on test requirements and hereby a�ests that the informa�on below
are true and correct.
Date of Present Examina�on Age Date of Birth

m m d d y y y y m m d d y y y y
First Name Ci�zenship / Na�onality

Male Female
Middle Name Home Address

Last Name No. / Street

Chapter/Gym Bgy. / Subd.

S T A R L A V A T K D
Instructor City / Municipality
M R G L E N N L A V A
Province
Present Grade/Degree
(Please use the legend provided) Zip Code

Mobile Number (Applicant)

(For Minors)
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 regula�ons of the PTA
for this promo�on 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 inflic�ng any inten�onal 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): `

Classifica�on:
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