Ukemi Kata (Teams or Pairs)
| Names | Age | Grade |
| 10 | 7 | 5 | 3 | 0 | -3 | notes | ||
| Presenting appearance and attitude | ||||||||
| Presenting salutation | ||||||||
| Â Â Â Â transition | ||||||||
| Ushiro ukemi | ||||||||
| Â Â Â transition | ||||||||
| Mae ukemi | ||||||||
| Â Â Â transition | ||||||||
| Migi yoko ukemi | ||||||||
| Â Â Â Â Â transition | ||||||||
| Hidari yoko ukemi | ||||||||
| Â Â Â Â Â transition | ||||||||
| Migi mae mawari ukemi | ||||||||
| Â Â Â Â Â Â transition | ||||||||
| Hidari mae mawari ukemi | ||||||||
| Â Â Â Â Â Â Â transition | ||||||||
| Closing salutation | ||||||||
| Points scored | TOTAL POINTS | |||||||
| Name of shinpan | Names of additional shinpans | |||
| General comments | ||||