Middle School Intake Form

Sign up to be a part of DREAM Alive!

If you would like to sign up for our Middle School program, please complete the sign-up form below. *Be sure to enter a VALID EMAIL ADDRESS for the guardian or parent as we will be sending updates and your waiver to the parent or guardian that is listed. If you have any questions, please contact our Middle School Director, Destiney Lee at 317-537- 7674.
Scholar Information
First Name*
Middle Initial
Last Name*
Grade*

6th7th8th
School Attending*

Howe Middle SchoolArlington Middle SchoolParamount Middle SchoolNorthwest Middle SchoolLongfellow Middle School
Please do not put in your IPS Email address. Please only use a personal email. DO NOT USE THE SAME EMAIL FOR BOTH GUARDIAN AND STUDENT. If you don't have an email, please type out [yourfirstname]@[yourlastname].com. Thank you
Student Personal Email (Not IPS)*
If you do not have an email please enter your firstname@lastname.com.
Student Cell Phone*
Please enter a valid phone number. If you do not have a phone number please enter (000) 000-0000.
Guardian Info
Guardian Name*

First NameLast Name
Guardian Email*
If you do not have a guardian email please enter their firstname@lastname.com.
Guardian Mobile Phone*
Please enter a valid phone number.
Should be Empty:

Sign up to be a part of DREAM Alive!