Little Heroes Testing Application Form

__________________________ Testing Date

Little Heroes Testing Application Form

Last Name: ___________________________ First Name:_____________________________________ Change of Address:____________________________________________________________________ City:______________________________State:________________________Zip:__________________ Change of Email Address:_______________________________________________________________ Parent/Guardian Name:_________________________________________________________________ Please check (√) one of the following:

My child is currently a –

□ White Belt □ Orange Belt □ Blue Belt

□ Yellow Belt □ Green Belt □ Brown Belt

(Test at 4:00 PM)

□ Purple Belt □ Red Belt

(Test at 4:30 PM) (Test at 5:00 PM)

There is a $25 promotional testing fee for Little Heroes. If your child would like to take the test on another day or time other than what is listed above a private test may be scheduled for an additional $10 fee. Please call the school to schedule. You can pay by cash, check or credit card. Just fill in the information below and submit the form by mail or in person with the correct fee before the test. □ Pay by check □ Pay by credit/debit card I authorize Wushu Central to charge/debit my card for the amount stated above. Card # _________________________________________ Exp: ____/____ Signature _________________________

VISA

MC

DISC

AMEX

(circle one)

****REMINDER**** In order to test, Little Heroes must have the following: ™ All eight color stripes on belt ™ Turn in testing fee ™ Please fill out student evaluation form on the reverse side of this page if your child is a WHITE belt, a GREEN belt, or a BROWN belt in Little Heroes 1331 Coleman Ave. Santa Clara, CA 95050 ● (408) 850-9479 ● www.wushucentral.com

Wushu Central Martial Arts Academy By taking a few moments to complete the following questionnaire, you can help us serve you better. Please do not hesitate to be completely honest. It will enable us to assist you (and your child) in fulfilling your goals. 1. Are you receiving the benefits or seeing the improvements you anticipated when you first joined Wushu Central Martial Arts? Yes no 2. Are you satisfied with the program? Yes no 3. Is earning the rank of Black Belt one of your goals? Yes no 4. Have you, or would you recommend a friend to try class? Yes no 5. Overall, do you feel as though this program was worth the investment? Yes no 6. Name two areas in which you have seen improvement in you/ your son/ your daughter. (IE home, attitude, etc.) A.___________________________________________________________________________________ B.___________________________________________________________________________________ 7. What do you like most about Wushu Central Martial Arts? _____________________________________________________________________________________ _____________________________________________________________________________________ 8. What, if anything, would you like to see changed or improved upon at Wushu Central Martial Arts? _____________________________________________________________________________________ _____________________________________________________________________________________ 9. What other personal or martial arts goals do you have that Wushu Central Martial Arts can help you realize? _____________________________________________________________________________________ _____________________________________________________________________________________ 10. What part of class do you like the most? _____________________________________________________________________________________ 11. What part of class do you like the least? _____________________________________________________________________________________ 12. Overall, how would you rate the quality of:

EXCELLENT

VERY GOOD

GOOD

NEEDS IMPROVEMENT

A. INSTRUCTORS ______________B. FACILITY_____________C. SCHEDULE________________ 13. Additional comments: _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ 1331 Coleman Ave. Santa Clara, CA 95050 ● (408) 850-9479 ● www.wushucentral.com