Grant Application Part Two

PLEASE NOTE:  There will be two parts of this application to complete and send.  The first part pertains to the group itself.  The second part pertains to the Greyhound in need of medical care.  Please make sure you send both parts of the application via email.  All required documentation and anything else that is necessary for application review, please scan and attach to email and/or send a hard copy via postal mail.

Please email the following required documentation:  Grant Application, 501©(3) backup data, bank statements and/or annual statement, dated proof of possession, veterinarian report and estimate to:

Email:  Teri Rogo

Please also send hardcopy to:  GREYT Legs, P O Box 41566, Phoenix, AZ  85080

To verify your request has been received, you may call:

Teri Rogo, President of GREYT Legs at 623-322-0659 or 602-228-2594

 

 

Please provide the following information:

 

What is the GREYHOUNDS Kennel Call Name?


What is the GREYHOUNDS Race Name?


 

Enter the Left Ear Tattoo #?


Enter the Right Ear Tattoo #?


Enter the U.S. Commissioned track the Greyhound raced at.


Which leg sustained break?

Left Front
Right Front
Left Rear
Right Rear

Was the break sustained while racing?

Yes No

Date break occurred :

-- mm/dd/yy

Did the GREYHOUND receive emergency treatment immediately at the track?

Yes No

If so describe the emergency treatment received by GREYHOUND?


Was there a x-ray taken?

Yes No

Was or is surgery required?

Yes No

Please provide the following Vet information:

Vets First Name
Vets Last Name
Clinic Name
Contact Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Phone
FAX
Home Phone
E-mail
URL

Has the Vet bill been paid?

Yes No

If the bill has been paid, by who?


Does the group have a rehabilitation program in place for broken leg GREYHOUNDS and for this particular GREYHOUND?

Yes No

If so briefly describe.


Does the group have a current on going fundraiser for this particular GREYHOUND?

Yes No

What tangible item(s) is the group providing to GreytLegs in lieu of grant monies received if approved??


Copyright © 2004 GreytLegs.   All rights reserved.
Revised: August 11, 2009