Name_______________________ Current Belt Rank__________ Test Belt Rank__________

Requirements        Grade                        Terminology

Basic Form            ______                       English___________________

Pal Gwe                 ______                       _________________________

Self Defense         ______                        Korean___________________

Sparring               ______                        _________________________

Breaking              ______

1) Have you seen any improvements in your child?__________________________________

___________________________________________________________________________

2) Has your childs behavior improved?____________________________________________

____________________________________________________________________________

3) Had your child's grades improved?_____________________________________________

___________________________________________________________________________

4) Are there any areas you want us to work on with you child?_______________________

___________________________________________________________________________

5) What do you like about Polaris Tae Kwon Do (class separation, schedule, membership options)?____________________________________________________________________

____________________________________________________________________________

6) Would like to see anything more or less of in class?_______________________________

___________________________________________________________________________