Register for Success For Sixth Grade

Are you ready for the 6th grade? Attend a one-day summer camp at your middle school and get to know the building, your locker, and some new friends before the 2019-20 school year begins!

Fill out the form below to sign up! For contact information and transportation information, download our flyer here:

  • Transportation will be provided to and from select elementary schools (see informational flyer), information on pick up and drop off times and locations will be mailed prior to program, please call success worker at your middle school with questions.

  • Emergency Information

    All information needs to be included and will be kept confidential.

  • Alternate Contacts in Case of Emergency:

  • By submitting this form, I agree to the following:

    I give full consent to the Des Moines Public Schools to use any photographs, audio, or video tapes taken of me while participating in SUCCESS 4 SIXTH GRADE, with no claim for payment, for any promotional/recognition activities of the program or school district.

    I assume all responsibility for any accidents or injuries that may occur, and release the Des Moines Public Schools staff and other educational consultants that provide services related to the middle school transition program of all liability. I understand that the Des Moines Public Schools and other staff are not responsible for any stolen or lost personal belongings. In case of accident, injury or sudden illness and I cannot be reached; I request that necessary medical care be instituted. Our physician/dentist may be contacted in case of medical treatment or as necessary and is authorized to release requested information as needed. The parent/student is responsible for all medical expenses.

    I also give my consent for the Des Moines Public School staff and other agencies affiliated with the middle school transition program to provide transportation in the course of their participation in SUCCESS 4 SIXTH GRADE.