2023 Five Star Life Fall Events at Summit

RESPECT - RESPONSIBILITY - COURAGE - INTEGRITY - SACRIFICE

* * * * *

Our events at our 350-acre Summit Leadership Training Facility are designed to develop and challenge your kids through incredible experiential learning opportunities infused with our mindset, leadership & character development curriculum. They will recieve valuable one-on-one and small group coaching from professionals in their fields and from highly trained Five Star Life staff and volunteers.

Enrollment for these events are limited, so register today!!

Summit Leadership Training Facility

14260 US-12, Union, MI 49130

This fall, Five Star Life will be offering:

Leadership Day Camps

** Lunch time will be given, but lunches will not be provided by Five Star Life. Please plan to pack a lunch.

Experiential Learning Centers may include: equine, rockwall, high ropes, nature education, archery, hatchet throwing, boating, fishing, and so much more!!
- Fall Leadership Day Camp at Summit (K-12th grade)
  - 10am - 2pm
  - Discount applies if registering for all five dates.
    
    $50/student/day
    
    $200/student/full camp (5 Days)
  - Dates (Every-other Saturday)
    
    October 7
    
    October 21
    
    November 4
    
    November 18
    
    December 2
Five Star Life Fall Events at Summit 2023

Please fill in the form below for each person who you are registering for.
Camper Information
Camper Name*

First NameLast Name
Preferred Name (if applicable)
School*
Gender*
Grade*
Grade is based on the last grade camper will have completed
Birthdate*

MonthDayYear
Date
Parent/Guardian Information
Parent/Guardian*

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

First NameLast 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?*

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. 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.

K-12th grade - Fall Leadership Days at Summit$50.00

K-12th grade students 10:00-2:00

Purchase Options	Quantity	Price
October 7		$50.00
October 21		$50.00
November 4		$50.00
November 18		$50.00
December 2		$50.00
DISCOUNTED BUNDLE: ALL FIVE DAYS		$200.00

Item subtotal:$0.00

Provide Scholarship for Campers in Need$50.00

Quantity
Item subtotal:$0.00

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 Fall Events at Summit 2023

Camper Information

Parent/Guardian Information

Health History

Liability Release

Payment