Black Belt Application

Kukkiwon Black Belt Application

Name of Association / Dojang

Recommended by

Recommender's Dan Certificate No.

I honestly recommend the person below as a well-qualified applicant for the Kukkiwon promotion test of Dan/Poom grades.

Applicant's Name *

First

Middle

Last

Date of Birth *

Email *

Phone *

Gender *

Male
Female

Address *

Address Line 1

City

State

Zip Code

Face Photo

*Photo will be embedded on certificate ID card.
File Extensions: png, jpg, gif / Files Size Limit:1MB /

Dan/Poom applied for *

Nationality (Citizenship) *

Signature *

I submit this application to the Promotion Board of Kukkiwon for a Promotion Test.

Website

Free Trial Lesson Request & Waiver

Enjoy a free Taekwondo class with a single click! If you send us your request as below, we will contact you to schedule your trial class (30 minutes).

Location
1673 Hollenbeck Ave, Sunnvyale, CA 94087
Call 408)733-2090 / Text 650) 690-2580

Student Name *

First

Last

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Student Date of Birth *

Student Gender

Male
Female

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Parent Name

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Email *

Phone *

Preferred trial date & time *

Previous martial art training history / Any information that you want us to know about the student who takes trial class

Liability Waiver *

I HAVE READ THE WAIVER, INDEMNIFICATION, AND RELEASE OF LIABILITY AND VOLUNTARILY EXECUTED THIS DOCUMENT WITH FULL KNOWLEDGE OF ITS CONTENT.

Recognition of Inherent Risks
I hereby understand and acknowledge that the equipment, facilities, training, programs, and/or events held by TG Taekwondo may expose me to many inherent risks, including accidents, injury, illness, permanent disability or even death. I assume all risk of injuries associated with participation including, but not limited to, falls, infections, contact with other participants, the effects of the weather, including high heat and/or humidity, weight lifting, use of equipment, participating in TG Taekwondo activities, and all other such risks being known and appreciated by me.

Responsibility to Communicate Physical Or Mental Restrictions In Writing
I hereby acknowledge my responsibility in communicating, in writing, any physical and psychological concerns, that might conflict with participation in activity, and presenting those concerns to the TG Taekwondo owner prior to participating. I acknowledge that I am physically fit and mentally capable of performing the physical activity I choose to participate in.

Waiver of Liability
By signing this Liability Waiver, I fully recognize and acknowledge that Taekwondo is a contact
sport and may result in physical injury to myself and/or others. Having a full understanding of these
risks, I wish to participate in the classes. I assume full and complete responsibility for any and all
damages or injuries that I may sustain or incur, if any, while participating in any Taekwondo activities. I do hereby release and further discharge TG Taekwondo’s owners, operators, any assistant instructors, or employees, for any personal injury that I may sustain while attending any class or activity. I also realize and acknowledge that I am solely responsible for any medical attention
or treatment that I may need as a result of my participation

Indemnification, Hold Harmless and Release
By the execution of this agreement, I agree, for myself and anyone entitled to act on my behalf, to fully and forever INDEMNIFY, HOLD HARMLESS, DISCHARGE, WAIVE AND RELEASE the TG Taekwondo, its officers, agents, employees, organizers, insurers, directors, associates, representatives, and successors from any responsibility for damages (both economic and non-economic), liabilities, demands, rights of action, causes of action, losses of any type, or claims of any kind, present or future, whether the same be known or unknown, anticipated, or unanticipated, resulting from arising out of the use of or my participation in the TG Taekwondo training, programs, events, equipment or facilities.

Compliance With Rules
I agree to comply with all rules imposed by the TG Taekwondo regarding the use of the facilities and equipment. I agree to conduct myself in a controlled and reasonable manner at all times, and to refrain from using any equipment, training, or property in a manner inconsistent with its intended design and purpose.

FOR PARENTS/GUARDIANS: By signing this Liability Waiver, I fully recognize and
acknowledge that Taekwondo is a contact sport and may result in physical injury to my child/ward.
Having a full understanding of these risks, I permit my child/ward to participate in the classes. I assume full and complete responsibility for any and all damages or injuries that he or she may sustain or incur, if any. I do hereby release and further discharge TG Taekwondo’s owners,
operators, any assistant instructors or employees, for any personal injury that my child/ward may
sustain while attending any class or activity. I also realize and acknowledge that I am solely
responsible for any medical attention or treatment that my child/ward may need because of his/her participation.

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Today's Date

Signature *

(650) 690-2580 *

I agree to receive communication SMS/texts from TG Taekwondo

Message and data rates may apply. You may revoke your consent at any time by responding STOP to any SMS text alerts you receive.

Phone