FSL Fall Programming October

Five Star Life Fall Programs at Summit 2020

Students grades 6-12 can join us this fall for a 6 week program designed to develop their skills and abilities in their specific program of choice, take them on a journey through our social-emotional learning curriculum, and hold them accountable to their academics. No equipment needed to attend.

Five Star Life Archery & Hatchet Throwing 101 (few spots available)

Five Star Life Horsemanship 101 (few spots available)

Five Star Life Nature Education 101 CLOSED (Fishing, Boating, Hiking, Gardening, and more!)

Cost: $150 (6 week program)

Schedule: Thursdays from 4:30-6:30pm (check in between 4:20-4:30) If unable to arrive until 4:40-4:45. Please inform the Business Office at events@fivestarlife.org.

** Dates Subject to Change**

October- 8, 15, 22, 29

November - 5, 12

Hosted at Summit:

14260 US Highway 12, Union, MI 49130

Questions?
Five Star Life Office: 574.266.4038

Email: events@fivestarlife.org

Please CLICK HERE to see SUMMIT’S COVID-19 GUEST POLICIES

Student Name *

First Name Last Name

Preferred Name (if applicable)

Gender *

Grade *

School *

Birthdate *

Date

Select Program *

Five Star Life Archery and Hatchet Throwing 101 Five Star Life Horsemanship 101

Parent/Guardian *

First Name Last Name

Phone Number *

Parent/Guardian E-mail (this is used to send updates with schedules, events and curriculum) *

Emergency Contact *

First Name Last Name

Emergency Contact Number *

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? *

Yes No

Explain.

2. Taking any current medications? *

Yes No

Explain.

3. Any heart problems or medications? *

Yes No

Explain.

4. Do you have high blood pressure? *

Yes No

Explain.

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

Yes No

Explain.

6. Do you have physical limitations? *

Yes No

Explain.

7. Do you have any special dietary needs? *

Yes No

Explain.

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

Low Medium High

Please include any additional information that you feel is relevant.

My Products

Entire Program (6 Weeks) $ 150.00

Payment Plan deposit $ 75.00

The final payment of $75 is due no later than October 15.

Concessions Tab $ 5.00

Pre-packaged items such as drinks, snacks, and ice cream. As well as Five Star Life Apparel. Unused concession money can go towards future events OR be donated.

Quantity

Enter coupon

Total $ 0.00

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Parent/Guardian Signature *

Five Star Life Programs at Summit

Student Information

Parent/Guardian Information

Health History

Liability Release