Middle School Registration Making a Difference in Your Community Saturday, November 21, 2026Meals from the Heartland357 Lincoln Street, West Des Moines, IA 50265 10:00 am

Student Name

First Name

MI

Last Name

Student Email Address

Student Phone Number (xxx-xxx-xxxx)

School

Demographics

Ethnicity

Hispanic/LatinoNon-Hispanic/Non-LatinoEthnicity Unknown

Gender

FemaleMaleNon-BinaryOther

Receive Free/Reduced Lunch

YesNo

Refugee Status

RefugeeNot a RefugeeRefugee Status Unknown

Parent/Guardian Information

First Name	Last Name
Phone Number (xxx-xxx-xxxx)	Email