Affiliate (Sub Chapter)/Satellite Pre-Screening Questionnaire

Thank you for your interest in becoming an affiliate of Greyhound Pets of America. Beginning on the road to organized greyhound adoption is a big step full of responsibility, but also very rewarding. In order to assist you in your inquiry about joining the GPA family, please answer the following pre-screening questions:

* Required fields

Name*

Address

City

State

Zip

Phone Number

Fax Number

Email*

1. Have you been, or are you currently active with a greyhound adoption group?

* Yes No

If so, please provide the following information:

1b: Name of the group

1c: Contact person

2. What is the proposed name and physical address of your group, if approved?

3. Why do wish to be affiliated with GPA?

4. How many volunteers do you have for initial start up?

5. Do you have a list of proposed Officers/Board Members?

* Yes No

If so, please provide their names and positions:

6. Do you plan to foster dogs in private homes, use a boarding facility, use a kennel at a track? Please explain:

7. How many foster homes do you currently anticipate having initially, and do you plan on drafting a foster agreement that will state clearly that GPA is not responsible for any physical and/or material damages that may occur while a greyhound is in their home?

8. Do you have a veterinarian willing to work with your group?

* Yes No

9. Where do you plan on getting the greyhounds that will be available for adoption?

10. Greyhound Pets of America is a non-profit organization, and is racing neutral. Do you and your proposed Officers, Board Members and volunteers all agree to maintain that position when dealing with the public, regardless of personal opinion?

* Yes No

11. If you are granted Affiliated Chapter status, do you have a mentoring chapter?

* Yes No

If not, do you agree that GPA National may assign one to you?

* Yes No

12. Does your group have a copy of the GPA National Policy and Procedures/Bylaws Manual, and/or your mentoring Chapter's same documents, and do you and all of your volunteers understand and agree to abide by these documents?

* Yes No

13. Does your group promise to spay/neuter any greyhounds placed by you before adoption, and provide an authorized GPA identification tag?

* Yes No

14. Do you agree to do a home visit prior to approving applications/placements?

* Yes No

15. Does your group fully understand that as an Affiliate Chapter, timely and accurate financial reports and an accurate tally of greyhounds placed must be provided to National at the end of each calendar year, and that the financial information will then be forwarded to the IRS?

* Yes No

16. Do you promise to provide this information, upon request, at any time, to the National Treasurer, or the Executive Secretary?

* Yes No

17. Do you agree to notify the necessary local and state agencies under which you operate, and to provide all documentation and information necessary to remain in good standing?

* Yes No

18. Describe your record keeping method for both your greyhound adoption process and tracking, as well as your financial records:

19. Do you understand that prior to being approved as a GPA member, the use of the GPA logo is expressly prohibited?

* Yes No

20. Finally, please explain what, in your opinion, constitutes a good, loving, responsible pet home for a greyhound:

21. Names of all currently proposed Officers and Board Members are required in the spaces provided below. By entering names, this acknowledges agreement to adhere to the GPA Mission Statement and Policy and Procedures, as well as Bylaws:

Enter any additional information that you feel is relevant to your application:

Thank You

Thank you for submitting your Affiliate Pre-Screening Questionnaire

You will be contacted shortly by a GPA representative

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