Five Star Life Summer Camp Days

Five Star Life Summer Camp Days Registration

Please fill in the form below.
Registration is now OPEN!

Join us at Summit (our 300 acre training facility) and experience various programming opportunities that are designed with our Five Star Life social and emotional learning curriculum. Learning Centers may include:

Target Adventure archery, hatchet throwing, target sports

Summit Adventure high ropes course, rock wall, team building

Nature Education boating, fishing, nature exploration, hike, gardening, birds of prey, biology, etc.

Equine horsemanship (miniature horse and quarter horses), farm experience

Five Star Life Arts arts and crafts, dance, creative writing, music)

Summit Games 9-square, gaga ball, carpet ball

Cost:

$40 per Five Star Life Summer Camp Day

Lunch is included

Scholarship Lottery

You can register to join the Scholarship Lottery below. Scholarships will be awarded based on the available funds. If you are chosen for a scholarshiped slot, your cost will only be $10.

Programs

**Due to the frequently changing circumstances, dates and available programs are subject to change. MORE PROGRAM DATES MAY BE ADDED WHEN SCHEDULED PROGRAMS SELL OUT**

Friday, June 18 Grades 3-12 (based on the last grade completed)

Saturday, June 26 Grades K-12 (based on the last grade completed)

Friday, July 9 Grades 3-12 (based on the last grade completed)

Saturday, July 24 Grades K-12 (based on the last grade completed)

Schedule:

Registration (AT SUMMIT): 9:00 am- 9:30 am

Pick-Up (at Summit): 4:00 pm

Five Star Life Office: 574.266.4038

Email: events@fivestarlife.org

Summit: 14260 US Highway 12, Union, MI 49130

Please CLICK HERE to see SUMMIT’S COVID-19 GUEST POLICIES
Student Information
Student Name *

First Name Last Name
Preferred Name (if applicable)
School *
Gender *
Grade *
Grade is based on the last grade completed
Birthdate *

Month Day Year
Date
Parent/Guardian Information
Parent/Guardian *

First Name Last Name
Phone Number *
Parent/Guardian E-mail (this is used to send updates with schedules, events and curriculum) *
Student E-mail
Emergency Contact *

First Name Last Name
Emergency Contact Number *
Health History
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.
Liability Release
Parent/Guardian Signature *

All payments are non-refundable.

Friday, June 18 $ 40.00

Grades 3-12

Saturday, June 26 $ 40.00

Grades K-12

Friday, July 9 $ 40.00

Grades 3-12

Saturday, July 24 $ 40.00

Grades K-12

SCHOLARSHIP LOTTERY Free

Scholarship is awarded based on availability. If chosen for scholarship, cost to parent is minimal.

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Five Star Life Summer Camp Days Registration

Student Information

Parent/Guardian Information

Health History

Liability Release