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