Application for Admission

Application for Admission

*Please note* Filling out this form does not guarantee enrollment. It only places you in the queue to be reviewed. You will be notified via email if your application has been approved.
Student Information 1
Name

First NameLast Name
M.I.
Birth Date

MonthDayYear
Date
Gender
Age
Student Information 2
Name

First NameLast Name
M.I.
Birth Date

MonthDayYear
Date
Gender
Age
Student Information 3
Name

First NameLast Name
M.I.
Birth Date

MonthDayYear
Date
Gender
Age
Student Information 4
Name

First NameLast Name
M.I.
Birth Date

MonthDayYear
Date
Gender
Age
If you have more than four children, please reach out to American Made after remittance of this form to add student(s).
Current Residence Information
Parent/Guardian Name

First NameLast Name
Parent/Guardian Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email Address
Alternate Email Address
example@example.com
Cell Phone Number 1

Area CodePhone Number
Cell Phone Number 2

Area CodePhone Number
Primary Residence Information (if different from above)
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Emergency Contact 1
Name

First NameLast Name
Phone Number

Area CodePhone Number
Is this person an authorized pickup person for your student(s)?

YesNo
Emergency Contact 2
Name

First NameLast Name
Phone Number

Area CodePhone Number
Is this person an authorized pickup person for your student(s)?

YesNo
Physician and Medical Information
Name

First NameLast Name
Phone Number

Area CodePhone Number
Preferred Hospital
Insurance/Health Coverage (Company)
Please list any of the following: Current medications, Medication allergies, Food allergies, Chronic health concerns.

Can your student(s) charge snacks to the account?

YesNo
Notes
Please inform American Made of any other vital information you think they may need to know in the event of an emergency. Thank you.
Students can only be picked up by authorized persons ONLY. Prior arrangements with Ms. Sam must be made in advance if a student is going to be picked up by an alternate person. The alternate person must be prepared to offer a valid form of identification when picking up the student.
Authorized Pick Up Person(s)
Important Information:

Please Note! Submitting this form does not guarantee enrollment. Your application will be reviewed by our Board of Trustees and you will be informed of a decision.
Should be Empty: