Rev.

6/1/2010

1ST DEGREE

BLACK BELT
CANDIDATE PACKET

Rev. 6/1/2010

ERNIE REYES
WEST COAST WORLD MARTIAL ARTS
.

PACKET CHECKLIST
STUDENT HANDOUT
Type written essay. 1-headshot size photo attached to the Black Belt Candidate Information Sheet. Fill out the Black Belt Candidate Information sheet by using the writeable PDF. Photocopy of your NEW YEARLY membership card (front and back). Read the Black Belt Training and Testing Release form carefully and sign. If under 18, parents must also read and sign the release. Current medical exam (must be within 12 months). Signed Accelerated Black Belt Training Invitation. Current (within 6 months) Report Card, with passing grades (if under 18 yrs). 1st Degree candidates sign the 6-month Certification and Leadership form. General Information: All ages should come prepared with (3) 3/4", 12" X 12" pine boards. If you are 10 and under, the boards should be 6" X 12". Bring all your sparring gear, Escrima sticks, knives, and bo staffs. You will not be allowed to spar without full equipment (head gear with face shield, chest protector, groin cup, mouth piece, safety hands and feet), and you will not pass this portion of the test. Bring a change of clothes and shoes. Be prepared for rain or cold weather during the conditioning regardless of a winter or summer test, and a water bottle. Be sure to drink extra water after your technical portion of the test, so your fluids will be replenished. If you need an inhaler, carry it with you at all times.

BLACK BELT CANDIDATE

Test fee:

1st Degree candidate: $400 2nd Degree candidate: $500 3rd Degree candidate: $500

Allpaperworkmustbeturnedinnolaterthan:DueDate:__________________ Allfeesmustbeturnedinnolaterthan:DueDate:__________________

WWW.ERNIEREYES.COM SANTACLARA@ERNIEREYES.COM (408) 984-1988 Ernie Reyes' West Coast World Martial Arts

Rev. 6/1/2010

ERNIE REYES
WEST COAST WORLD MARTIAL ARTS BLACK BELT CANDIDATE

INFORMATION SHEET
Name _______________________________ Birth Date ____________ Age ____ Sex ____ Address _________________________________________Phone _____________________ E-mail Address ________________________________@____________________________ City ____________________________________ State _______ Zip Code ______________

Black Belt Test Date _________________ Last Test Date _______________ Degree ______ Red/Black Test Date ___________________ Membership Number ____________________ _____________________________________________ Instructor _____________________ Ernie Reyes Martial Arts School Location

Applying for _____ Degree Belt Size _____

Instructors Signature __________________________

Attach 1- headshot photo this size here!

TYPEWRITTEN:
This form must be typewritten either by you or your martial arts school. Fill out the Black Belt Candidate Information sheet by using the writeable PDF. It can possibly be sent to you by your instructor.

REPORT CARD:
If you are a student in high school or below, please attach your report card for the previous 6-months to the back of this information sheet. You must have passing grades to test.

WWW.ERNIEREYES.COM SANTACLARA@ERNIEREYES.COM (408) 984-1988 Ernie Reyes' West Coast World Martial Arts

Rev. 6/1/2010

ERNIE REYES
WEST COAST WORLD MARTIAL ARTS BLACK BELT CANDIDATE

INVITATION TO BLACK BELT TRAINING

Congratulations! You have been invited to attend the Ernie Reyes West Coast World Martial Arts Association Black Belt Training. It consists of 10-12 consecutive Saturdays from 7:00 am to approximately 9:00 am. It culminates in a Black Belt Test Tryout before a board of Black Belt judges. The location for the Association training will be announced by your instructor, however some of the Saturdays in the 10-12 week course will be held at the tournament location, or at another venue, at times. There will be no training on certain holidays. If there are any changes, you will be informed by your instructor. Before you attend the Association training, you must complete and turn in everything in your Black Belt information packet, including your current medical exam. You must bring your Emergency Contact and Attendance Card with you to the soccer field. If you do not have any of these items or fail to attend any of the Association trainings without permission, you will not be allowed to participate, and you will fall out of the Black Belt Testing Cycle. Wear layers of warm clothes, and good running shoes. Bring water, and if you have asthma bring your inhaler. 1st Degree Candidates bring your boxing gloves, sticks with your name and school written on them, and mouthpiece. 2nd Degree candidates bring your boxing gloves, sticks, hard-rubber training knife, and mouthpiece. 3rd Degree candidates and up, bring your boxing gloves, sticks, hard-rubber knife, bo-staff, head gear with face shield, and mouthpiece. You have been given the opportunity to receive accelerated training with Ernie Reyes' West Coast World Association "Top Gun" staff. This privilege will enhance your chances for passing the Black Belt Test Tryouts at the end of your 10-12 week cycle, but it is NOT a guarantee that you will be testing for your Black Belt. After you have completed your 10-week course and tryout, it is possible that your instructor and/or the Black Belt Board may not pass you to take the Black Belt Test, and you will be asked to complete another Black Belt Training Cycle. Do not accept this invitation if you cannot respect your instructor and Black Belt boards decision, and bow out gracefully. Our mission is to uphold the highest standards at Ernie Reyes West Coast World Martial Arts, and to make sure each student performs to his or her potential best. This tradition has given us the reputation of producing some of the best Black Belts in the world in all categories of martial arts training, education, and competition. We have the deepest respect and honor for those students who have accepted our decisions to practice harder and come back the next time, or the time after that, or even the time after that. Having the courage to persevere develops a role model of excellence. This is what martial arts training was intended to develop, the indomitable spirit to never quit! If you decide to take advantage of this special training, and accept your instructors decision, please sign below and get ready for some intense, exciting, and empowering training. Are you ready for some dramatic change in becoming a peak performer?

NOTE: Parents please take time to sit down with your child and make sure you read them this invitation so that
they understand the seriousness of their Black Belt training and their commitment to become their personal best! _______________________________
Parent Signature Student Signature Date

__________________________ __________________________
Instructor Signature ERWCWMA

____________

_______________________________
School Location

Ernie Reyes West Coast World Martial Arts

Rev. 6/1/2010
ERNIE REYES
WEST COAST WORLD MARTIAL ARTS

TRAINING AND TESTING RELEASE

Name:_________________________________________________________ Gender:______________ Age:________ Address________________________________________________________ Telephone:________________________
I wish to participate in Ernie Reyes West Coast Martial Arts Association, Inc., Promotions Inc., Ernie Reyes West Coast Tae Kwon Do Karate Inc., Association Black Belt Training and Testing. I understand that my participation is subject to medical approval and that it is my responsibility to ensure that the physician who examines me is provided by me with all medical information about me which is known by me or reasonably available to me. I have fully cooperated with my physician to ensure that the Medical Exam Form is complete and accurate as possible. I further authorize Ernie Reyes West Coast Martial Arts Association, Inc. and its agents, employees, officers, assigns and representatives to contact my physician named on the Medical Exam Form to verify the date of my medical examination and to confirm that I was advised of the results of the physical examination. The authorization to contact my physician is valid as long as I am a participant in the Ernie Reyes West Coast Martial Arts Association, Inc. Association Black Belt Training and Testing, unless I otherwise inform Ernie Reyes West Coast Martial Arts Association, Inc. in writing. I understand that Ernie Reyes West Coast Martial Arts Association, Inc. may at any time deny me participation in its Black Belt Training and Testing program, even if my physician has declared me medically and physically fit for participation. ASSUMPTION OF RISK I understand that Martial Arts is a dangerous sport that involves vigorous physical activity and physical contact. Martial Arts training and testing may result in engaging in activity that increases my risk of injury. Such activities may include, but not be limited to: running races, obstacle course, or climbing while disoriented; sparring, practicing or competing with others who may be negligent, larger or smaller than me, older or younger than me, more skilled than me, less skilled than me, unable or unwilling to follow instructions, or who otherwise engage in a conduct that could cause me injury; failing to follow instructions, or failing to seek clarification or further assistance when I am not sure of instructions or do not understand the instructions; using equipment which may be obsolete, unsafe, poorly maintained, or otherwise dangerous; misusing or abusing equipment. I understand that it is my responsibility to ensure that I follow instructions fully and properly and that I use safe, well-maintained equipment. It is my responsibility to inspect all equipment fully and thoroughly prior to use. I understand that I am assuming all risk of injury and all liability associated with, relating to, or arising out of my participation in Ernie Reyes West Coast Martial Arts Association, Inc. Association Training and Testing. I understand that my participation may at times involve transportation to several locations and that I am assuming all risk of injury and all liability associated with, relating to, or arising out of the transportation to any location. I understand that I may be given first aid and that I am assuming all risk of injury and all liability associated with, relating to, or arising out of the first aid treatment. This Assumption of Risk includes all risk of any injury of any kind for any negligence of any kind by Ernie Reyes West Coast Martial Arts Association, Inc., Promotions Inc., Ernie Reyes West Coast Tae Kwon Do Karate Inc., and any of its officers, directors, shareholders, employees, instructors, promoters, event coordinators, sponsors, agents, representative, successors, affiliated WCWMA Association Martial Arts schools of any kind, and all locations including, but not limited to rehersal, practice, event, or testing locations, or while in or upon the property utilized by Ernie Reyes West Coast Martial Arts Association, Inc. By signing this document, I understand that I cannot hold Ernie Reyes West Coast Martial Arts Association, Inc., Promotions Inc., Ernie Reyes West Coast Tae Kwon Do Karate Inc., any of WCWMA Association Martial Arts Schools, or any of their officers, instructors, directors, employees, agents, representatives or successors liable for any negligent act relating in any way to my participation in Ernie Reyes West Coast Martial Arts Association, Inc. Black Belt Training and Testing. I understand that this release is valid and enforceable to the extent it is valid under law and public policy. This Assumption of Risk does not require me to assume any risks to the extent the law or public policy would find such assumption valid. If any portion of this document is determined to be invalid or unenforceable, all remaining portions of this document shall remain valid and enforceable. If any portion of this document is determined to be invalid or unenforceable as applied to particular places, people, and/or circumstances, all remaining portions of this document shall be valid and enforceable as applied to those places, people, and/or circumstances, and the entire document shall be valid and enforceable as applied to other places, people or circumstances. I hereby agree that I give permission and all rights, to use my being and likeness in any written material, photos, video, regarding any productions of Ernie Reyes West Coast World Martial Arts Association, Promotions Inc., and Ernie Reyes West Coast Tae Kwon Do Karate Inc. during association training. This also pertains to any publicity, publication, video, internet use or product Ernie Reyes West Coast World Martial Arts, Promotions Inc., Ernie Reyes West Coast Tae Kwon Do, Inc., wish to produce, promote, or commercialize within the organization or outside businesses. _______________________________ Date Ernie Reyes West Coast World Martial Arts _____________________________________________ Participant (Parent or Guardian if Participant is under 18 years of age)

BLACK BELT CANDIDATE

Rev. 6/1/2010

ERNIE REYES
WEST COAST WORLD MARTIAL ARTS BLACK BELT CANDIDATE

MEDICAL EXAM FORM

Name_______________________________________________ Sex _______ Age_____ Address_________________________________________________________________ City ________________________________________ State__________ Zip _________
Check Off

1. Above patient has been evaluated to be in good health and is cleared medically and physically to participate in Ernie Reyes' World West Coast Association Black Belt Training and Testing which will include strenuous physical activity and physical contact. 2. Above patient is not cleared for: Contact Strenuous Activity

Due to: _________________________________________________________________ Recommendation:

_________________________________________________________ _________________________________________________________
3. List any current medications or medical conditions, which we should be aware of.

__________________________________________________ __________________________________________________ __________________________________________________

Name of physician________________________________________ Date ____________ Address _________________________________________________________________ Signature of physician ______________________________________________________ I am fully aware of the above medical conditions and I elect to participate in the Black Belt Training and Testing. Signature ________________________________________________________________ (If under 18 years of age, parent must sign.)

Ernie Reyes West Coast World Martial Arts

Rev. 6/1/2010

ERNIE REYES
WEST COAST WORLD MARTIAL ARTS BLACK BELT CANDIDATE

6-MONTH CERTIFICATION AND LEADERSHIP PROGRAM

CERTIFICATION QUALIFICATION IS A MUST! I am fully aware that the final phase of my 1st degree Black Belt Test consists of a 6-month Certification and leadership program. I am aware that I will not receive my 1st degree Black Belt diploma, or my 1st degree embroidered WCWMA Black Belt and certificate, if I do not meet the following requirements: 1.) I know that I must still be consistent with my training after my Black Belt test, making sure I integrate my Black Belt martial art skills that I have learned for my Black Belt test to make sure they become a second nature response. I understand that I must take a minimum of 2-classes per week. I will commit to staying consistent with my training. Two classes per week ________ More than two classes per week ________ 2.) I also realize as a Black Belt I will be a role model of excellence during classes to show that I can lead by example! This is part of our leadership development program. As mentioned above, I am aware that if I do not fulfill the certification requirements, during the 6-months following my 1st Degree Black Belt test, I will forfeit my West Coast World Martial Arts Black Belt diploma and official West Coast embroidered Black Belt. _____________ Date ____________________________________ Student Signature ____________________________________ Parent if under 18 years old

Ernie Reyes West Coast World Martial Arts

Rev. 6/1/2010

ERNIE REYES
WEST COAST WORLD MARTIAL ARTS BLACK BELT CANDIDATE

TRAINING JOURNAL
KEEPING A JOURNAL IS A MUST, IN DEVELOPING THE BLACK BELT MINDSET!
Part of your Black Belt training is creating a journal of your activities during your training cycle. The journal is used as a tool for you and your instructor to analyze your progress, and enable you to make changes where necessary. You will need a six-part binder that will contain the following:

6-TITLES AND TAB DIVIDERS FOR YOUR BLACK BELT JOURNAL:

1. Technical Areas of Improvement This is where you log the small detailed corrections on your martial arts skills that your instructor points out to you each day. It is important that you correct these areas of improvement NOW! Then you will need to create a plan to correct your mistakes. 2. Peak Performance Diet Log everything you eat or drink on a daily basis. Be as detailed as possible. Eat to be healthy! Eat to win! Eat to become a Champion! 3. Supplemental Training This should include all training other than martial arts, for example; running programs, weight training, kardio kickboxing, etc.... How much? How long? When? 4. Martial Arts Training Document all your training on a daily basis. 5. Giving Value/Diary This section is for you to focus on giving value back to your family, friends, or community. Log anything that you did for other people without expecting anything in return. 6. Mental and Emotional Documentation This is your diary for any thoughts that you might have for that particular day. How do you feel? The majority of time you will be up. Write about it. There will be times when you feel things are challenging in your life. You must record these difficult moments also, because as you learn to conquer yourself to overcome these obstacles, you will have a reference that hard work and perseverance will eventually bring you success and happiness. NOTE: Remember, your Black Belt Test isn't just the day of the test. Its everything you did up to that point to prepare yourself for one of the most powerful events of your life. If your life is worth living, it is worth documenting.

Ernie Reyes West Coast World Martial Arts

Rev. 6/1/2010

ERNIE REYES
WEST COAST WORLD MARTIAL ARTS BLACK BELT CANDIDATE

st

DEGREE ESSAY QUESTIONS

1. What is the Black Belt Mindset? Do you have it? 2. How has martial arts changed your life for the better? Please give me 5-examples and explain. 3. What makes you think you are ready to become an Ernie Reyes West Coast World Martial Arts Black Belt? 4. Do you try to apply your martial arts to your everyday living? 5. How does martial arts at Ernie Reyes West Coast World Martial Arts differ from other martial art schools? 6. Describe your WCWMA Head Instructors history, philosophy, and achievements, as well as KJN Ernie Reyes and KJN Tony Thompson. 7. Evaluate each instructor at your school. 8. What can you do to give value to others? Include a specific example of a time when you gave value to someone that made a positive impact on his or her life. 9. Can martial arts be important in developing maturity and responsibility? List examples of martial arts responsibility. 10. What are the 4-pillars of Strength of our WCWMA Association? How can this Ultimate Success Formula help you in other areas in your life?

NOTE: Each answer must be at least a paragraph long, and essays must be typed.

Ernie Reyes West Coast World Martial Arts

Rev. 6/1/2010
Rev. 6/1/2010 Rev. 6/1/2010

Black Belt Testing Packet Checklist

NOTE: Highlighted area means incomplete.

Black Belt Testing Packet Checklist

NOTE: Highlighted area means incomplete.

LEFT SIDE OF PACKET: 1. Info Sheet 2. 1-Photo 3. BB Training Invitation 4. Testing Release 5. Medical Exam 6. Report Card 7. Essay Questions 8. Membership Card RIGHT SIDE OF PACKET:

CHECKED OFF BY SCHOOL

CHECKED OFF BY ASSOC.

LEFT SIDE OF PACKET: 1. Info Sheet 2. 1-Photo 3. BB Training Invitation 4. Testing Release 5. Medical Exam 6. Report Card 7. Essay Questions 8. Membership Card RIGHT SIDE OF PACKET:

CHECKED OFF BY SCHOOL

CHECKED OFF BY ASSOC.

_____ _____ _____ _____ _____ _____ _____ _____

_____ _____ _____ _____ _____ _____ _____ _____

_____ _____ _____ _____ _____ _____ _____ _____

_____ _____ _____ _____ _____ _____ _____ _____

1. Black Belt Test 1st, 2nd, or 3rd 2. Life Skills Test 3. 6-month Certification Form

_____ _____ _____

_____ _____ _____

1. Black Belt Test 1st, 2nd, or 3rd 2. Life Skills Test 3. 6-month Certification Form

_____ _____ _____

_____ _____ _____

Rev. 6/1/2010

Rev. 6/1/2010

Black Belt Testing Packet Checklist

NOTE: Highlighted area means incomplete.

Black Belt Testing Packet Checklist

NOTE: Highlighted area means incomplete.

LEFT SIDE OF PACKET: 1. Info Sheet 2. 1-Photo 3. BB Training Invitation 4. Testing Release 5. Medical Exam 6. Report Card 7. Essay Questions 8. Membership Card RIGHT SIDE OF PACKET: 1. Black Belt Test 1 , 2 , or 3 2. Life Skills Test 3. 6-month Certification Form
st nd

CHECKED OFF BY SCHOOL

CHECKED OFF BY ASSOC.

LEFT SIDE OF PACKET: 1. Info Sheet 2. 1-Photo 3. BB Training Invitation 4. Testing Release 5. Medical Exam 6. Report Card 7. Essay Questions 8. Membership Card RIGHT SIDE OF PACKET:

CHECKED OFF BY SCHOOL

CHECKED OFF BY ASSOC.

_____ _____ _____ _____ _____ _____ _____ _____

_____ _____ _____ _____ _____ _____ _____ _____

_____ _____ _____ _____ _____ _____ _____ _____

_____ _____ _____ _____ _____ _____ _____ _____

rd

_____ _____ _____

_____ _____ _____

1. Black Belt Test 1st, 2nd, or 3rd 2. Life Skills Test 3. 6-month Certification Form

_____ _____ _____

_____ _____ _____