Katame-no-Kata (1st set only)
| Names | Age | Grade | |
| Tori | |||
| Uke |
| 10 | 7 | 5 | 3 | 0 | -3 | notes | ||
| Presenting appearance and attitude | ||||||||
| Presenting salutation | ||||||||
| Â Â Â Â transition | ||||||||
| KuzureKesa-gatame | ||||||||
| Â Â Â transition | ||||||||
| Kata-gatame | ||||||||
| Â Â Â transition | ||||||||
| Kami-shiho-gatame | ||||||||
| Â Â Â Â Â transition | ||||||||
| Yoko-shiho-gatame | ||||||||
| Â Â Â Â Â transition | ||||||||
| KuzureKami-shiho-gatame | ||||||||
| Â Â Â Â Â Â transition | ||||||||
| Closing salutation | ||||||||
| Points scored | TOTAL POINTS | |||||||
| Name of shinpan | Names of additional shinpans | |||
| General comments | ||||