Equine Programs Registration

Five Star Life Equine Programs at Summit 2024

Please fill in the form below.
Current Program Options:

Five Star Life Private Lessons:

Ages 5+, multiple days/times available (Contact Five Star Life prior to registering)

Single Lesson: $50.00

Package of 4 Lessons: $180.00

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Five Star Life Group Lessons (2 Riders):

Ages 5+, multiple days/times available (Contact Five Star Life prior to registering)

Single Lesson: $75.00

Package of 4 Lessons: $280.00
Five Star Life Equine Experiences at Summit*

Five Star Life Private Lessons (1 lesson)Five Star Life Private Lessons (4 lessons)Five Star Life Group Lessons (1 lesson, 2 riders)Five Star Life Group Lessons (4 lessons, 2 riders)
Have you previously filled out a Summit Equine Registration form?*

Yes (for a previous event)No (this is my first Summit Equine Event in 2022)
Student Information
Student Name*

First NameLast Name
Age*
Contact Information
Parent/Guardian*

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

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
Parent/Guardian Signature*
Payment

All payments are non-refundable.

FSL Private Lesson (Single lesson)$50.00

Quantity

FSL Private Lessons (4 Lessons)$180.00

Quantity

FSL Group Lessons (Single Lesson)$75.00

Quantity

FSL Group Lessons (4 Lessons, 2 Riders)$280.00

Quantity

Enter coupon

Total $0.00

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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 2024