GREAT TAEKWONDO ACADEMY

Tel: 019-9242435 Email: greattaekwondoacademy@gmail.com

Nombor Pendaftaran: KT0425189-P

BORANG UJIAN PENINGKATAN TALI PINGGANG

KATEGORI COLOUR BELT (JUNIOR)

Nama
Name

Alamat
Address

No. K/P / MyKid Tarikh Lahir

I.C./ Birth Cert. Date of Birth

No. Dihubungi Jantina Male/Boy[ ] Female/Girl [ ]

Contact No. Gender Lelaki Perempuan

Negeri
State

Sekolah
School

Talipinggang Colour Belt Grade [ ] Black Belt [ ] Degree

Grade/Degree

Bayaran Ujian RM50.00 TUNAI [ ] TRANSAKSI ONLINE [ ]

Grading Payment RM50.00 CASH ONLINE TRANSFER

Pelaksanaan LAYAK TIDAK LAYAK

[ ] [ ]
Performance Available Not Available

Kebenaran dari ibubapa bagi peserta bawah 18 tahun (Parental permission required for participants below 18 years’ old)
Saya adalah peserta/ ibubapa/penjaga bagi pelajar saperti di atas, faham dan maklum bahawa pihak akademi telah mengambil semua
tanggungajwab yang sewajarnya bagi ujian ini. Oleh itu sebarang kecederaan, kehilangan atau sebarang kemalangan adalah tanggungjawab
sendiri dan tidak akan disabitkan kepada pihak akademi serta sedia menerima sebarang peraturan, keputusan dan ketetapan yang
diputuskan oleh pemeriksa. Saya setuju dan memberi kebenaran kepada pelajar seperti nama di atas.
I participant /the parent/ the guardian of the above named understand and acknowledge that the Organisers have made and taken all reasonable care and arrangement for
the mentioned event and shall not hold the Organisers or its agents, servants or volunteers liable for any negligence, injury, loss or whatsoever claim arising directly or
indirectly from the above event and further acknowledge that the Organiser shall not be liable to additional room charges incurred or any other incidental or any loss or
damages that arise there from and further agree to abide by the rules and direction of the Examiner for the purpose of the grading. Accepted for and behalf of the above
named

………………………………. ………………………………
NAME/PARENT (Nama): COACH
No. K/P (NRIC): (Jurulatih)

Tarikh (DATE):