Equine Program Registration

Five Star Life Equine Programs at Summit 2025

Please fill in the form below for each student being registered.
After purchasing your Private Lesson Package, a Five Star Life Coach will reach out to schedule dates and times that work with your schedule.

All Payments are Non-Refundable

Scheduled lessons canceled 24 hours or more in advance may be rescheduled. Any lessons canceled within 24 hours of the scheduled lesson start will not be eligible to be rescheduled, and the lesson and funds will be lost.

Five Star Life Private Lessons:

Ages 5+, multiple days/times available

Single Lesson: $70.00

Package of 4 Lessons: $260.00
Select the Age of the Private Lesson Student Being Registered*

5 Years - 17 Years of Age18 Years of Age or Older
Student Information

For Students 5 Years - 17 Years of Age
Student Name*

First NameLast Name
Age*
Parent/Guardian Contact Information

For Registrations of Students 5-17 Years of Age
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Phone Number*
Parent/Guardian Email*
Emergency Contact Name*

First NameLast Name
Relationship to Student*
Emergency Contact Number*
Adult Student Information

For Registrations of Students 18 Years of Age or Older
Student Name*

First NameLast Name
Student Phone Number*
Student Email*
example@example.com
Emergency Contact Name*

First NameLast Name
Relationship to Student*
Emergency Contact Number*

Summit Release Form
NOTE: All PARTICIPANTS must have an up-to-date signed Health History Form as well as Assumption of Risk, Liability Release, Indemnity Agreement, Picture and Video Waiver and Release to participate in any leadership experience at Summit.

PLEASE READ AND ANSWER THE QUESTIONS BELOW: This form is intended to remind leaders and participants of the seriousness of attempting adventure activities with an old preexisting injury, a heart condition, or other condition which might be aggravated by the event. Please connect with a Summit facilitator if you need to share any additional and pertinent information.
1. Any preexisting injuries (ankle, neck, back, knee, wrist, shoulder, etc.) that might be aggravated by participating?*

YesNo
Explain.
2. Taking any current medications?*

YesNo
Explain.
3. Any heart problems or medications?*

YesNo
Explain.
4. Do you have high blood pressure?*

YesNo
Explain.
5. Do you have allergies (bees, insects, medications, etc.)?*

YesNo
Explain.
6. Do you have physical limitations?*

YesNo
Explain.
7. Do you have any special dietary needs?*

YesNo
Explain.
8. Are you pregnant?

YesNo
9. What is your current level of activity back at home?*

LowMediumHigh
Please include any additional information that you feel is relevant.
Liability Release
Signature (Signed by Parent/Guardian for Students 5 Years - 17 Years of Age) *
Payment

All payments are non-refundable.

Please note: dates/programs are subject to change based on enrollment and availability. If changes occur, you will be notified in advance and registration fee can be applied to alternative program/date.

Questions? Call us at 574.266.4038 or email us at events@fivestarlife.org
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Five Star Life Equine Programs at Summit 2025