Application

It is our desire to give dolls to girls who need something good to happen and an American Girl® Doll is that "something."

To assure that this happens, we prefer applications come from a friend, relative, parent, counselor, teacher, doctor, pastor or other official person in the life of the girl.

If you would prefer to mail your application instead of filling out the form below, please send the information below to:

Madison’s Hope, Inc.
Lindsey Rokusek
PO Box 181
Harrisburg, SD. 57032

or email application information below to:

lindsey@madisonshopeinc.org

Name of Adult Applicant

First Name

Last Name

Email of Adult Applicant

Address of Adult Applicant

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone # of Adult Applicant

(###)

###

####

Position of Adult Applicant (or Relation to Girl)

Girl's Name

First Name

Last Name

Girl's Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Girl's Age

Parent's Name

First Name

Last Name

Parent's Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent's Email

Reason for the Request

Preferred characteristics of Doll (hair color, skin color, or eye color**)

Address Where Doll Will Be Sent

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Do you have parental approval for doll to be given?

**We will accommodate preferences depending on availability.

Application

Madison’s Hope, Inc.
Lindsey Rokusek
PO Box 181
Harrisburg, SD. 57032

lindsey@madisonshopeinc.org

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Application

Madison’s Hope, Inc.Lindsey RokusekPO Box 181Harrisburg, SD. 57032

lindsey@madisonshopeinc.org

Madison’s Hope, Inc.
Lindsey Rokusek
PO Box 181
Harrisburg, SD. 57032