Five Star Life Programs at Summit

Summit Open Program Registration
ELKHART COMMUNITY SCHOOLS RISING 6TH GRADE STUDENTS

TO REGISTER FOR SUMMER LEARNING LABS, VISIT THE REGISTRATION FORM LINKED BELOW!!

SUMMER LEARNING LABS REGISTRATION
$25 OFF ALL SUMMER PROGRAMS THROUGH MAY 11th
Financial Aid For Those in Need!!

You MUST submit this completed program registration form BEFORE applying for financial aid.

1. Read the Five Star Life Financial Aid Overview Below

2. Enter Coupon Code 5STAR-SCHOLARS at checkout.

3. Pay the Non-Refundable Deposit within this Registration Form

4. Apply for financial aid and complete the process to see what you qualify for using the overview QR Code or by accessing the application link HERE!

Financial Aid Offers vary and are assessed and awarded on a case-by-case basis. Please ensure you have read and understand the overview before registering for this program
Summit Clubs
- Pricing: $175 per club
- Age: 5th - 12th Grade (based on rising grades in Summer)
- Time: 5:00pm - 7:00pm
- Summit Address: 14260 US-12, Union, MI 49130
- Program Description: Club sessions include Five Star Life Curriculum, experiential learning, and high-quality lessons for a variety of skill levels. Club skill development is focused on Equine, Archery, Blacksmithing, and trade skills, and are led by highly trained and qualified Five Star Life Coaches with expertise in their respective areas.
- For financial aid inquiries, visit the top of this registration form for information and instructions.
Summer Summit Club
- Dates: Every Tuesday; June 2 - July 7
- Registration Closes May 19
Fall Afterschool Club
- REGISTRATION OPENING JUNE 1 - Check back then to claim your early-bird discounted price.
Winter Afterschool Club
- REGISTRATION OPENING AUGUST 10 - Check back then to claim your early-bird discounted price.
Student Information
Student Name

First NameLast Name
Preferred Name (if applicable)
School
Gender
How did you hear about these program opportunities?
Grade
Grade is based on the last grade student will have completed
Birthdate

MonthDayYear
Date
Address (Primary Residence)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Information
Parent/Guardian

First NameLast Name
Phone Number
Format: (000) 000-0000.
Parent/Guardian E-mail (this is used to send updates with schedules, events and curriculum)
Address (Primary Residence)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact

First NameLast Name
Emergency Contact Number
Format: (000) 000-0000.
Household Information *OPTIONAL*

This information is used to help us make the most informed decisions to serve our families in the best possible ways.
Household Size
Household Income
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?
Explain.
2. Taking any current medications?
Explain.
3. Any heart problems or medications?
Explain.
4. High blood pressure?
Explain.
5. Any allergies (bees, insects, medications, etc.)?
Explain.
6. Any physical limitations?
Explain.
7. Any special dietary needs?
Explain.
8. Current level of activity back at home?
Please include any additional information that you feel is relevant.
8. Immunization status up-to-date?
Please include any additional information that you feel is relevant.
9. Any other special health or behavioral considerations?
Please include any additional information that you feel is relevant.
Emergency Medical Release
Liability Release
Parent/Guardian Signature
Payment

Select an age category to filter available program options for you!

Summer Summit Club$175.00

Donation Opportunity$25.00

Donate to the Five Star Life Scholarship Fund to Help Other Students in Need. Scholarship donations are in $25 increments, spanning from $25-$250 depending on the quantity selected. For donations over $250, please directly contact the Five Star Life central office at the phone number listed below to learn how you our your business can become a sponsor.

Quantity
Item subtotal:

Enter coupon

Total $0.00

Payment Methods

Credit Card

Apple Pay

Google Pay

ACH Bank Transfer

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 info@fivestarlife.org
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Summit Open Program Registration

Student Information

Parent/Guardian Information

Household Information *OPTIONAL*

Health History

Emergency Medical Release

Liability Release

Payment

Select an age category to filter available program options for you!*

Payment Methods

Household Information OPTIONAL

Select an age category to filter available program options for you!