Prevention Council Re-Chartering Agreement

Prevention Council Re-Chartering Agreement

This document establishes the agreement between Prevent Child Abuse Indiana, a Division of The Villages, (heretofore referred to as “PCAIN”) and (type Your Council's Name)

(heretofore referred to as “PCAIN Chartered Council”) for the period of January 1st to December 31st.

The Agreement

The agreement between PCAIN and all PCAIN Chartered Councils is based on the mutual understanding that we will continually work together to build a statewide organization and network that enables all sectors of the community to play a significant role in preventing child abuse and neglect.

Mutuality of Agreement

In affirmation of our agreement, both PCAIN and the PCAIN Chartered Council will support and promote one another to the greatest extent possible. It is respectfully understood that each of our activities in some way reflects on Prevent Child Abuse America (PCAA) as well as our state and local images. Each entity must take great care to ensure that our actions correspond with the vision, core values, guiding principles and position statements established by PCAA.

PCAIN Responsibilities

PCAIN has a commitment to provide technical assistance to Chartered Councils, resources permitting. Chartered Councils will receive all established benefits, outlined in Appendix A.

Council Responsibilities

Chartered Councils are expected to maintain compliance with the criteria for PCAIN Chartered Councils throughout the charter period (Appendix B). Should there be any major change in a Council’s organization or in its ability to be in compliance with the criteria, the Council agrees to notify PCAIN in writing within sixty (60) calendar days.

The Charter

This charter acknowledges that the PCAIN Chartered Council is in compliance with the criteria of PCAIN and is granted annually. When a charter is granted, the PCAIN Chartered Council will pay a yearly Chartering Fee. Chartering fees are not refundable.


The Appendices (A through H) are considered an integral part of this Chartering Agreement and can be accessed on the PCAIN Council Portal at under Council Documents.


As an authorized officer of

I hereby certify that our organization is applying to be a Chartered Prevention Council of Prevent Child Abuse Indiana. I further certify that we understand this agreement (including all Appendices) and that we will maintain compliance with it.
President (or Presiding Officer)

Primary Contact Information

This information will appear on the Prevent Child Abuse Indiana website so that people can contact your Council. It is important that the contact person is available to receive information. We will also use this information to send postal mail.

Responsibilities of the Primary Contact Person are:

  1. Be available to the PCAIN Staff through email and phone
  2. Act as the messenger to the rest of your Council’s Officers and Volunteers
  3. Notify PCAIN Staff of any Officer or Contact changes
Mailing Address
Mailing Address
Preferred Phone Type
Alternate Phone Type
Shipping Address
Shipping Address
Does your Council operate under the umbrella of another organization and use their 501c3?
Does your Council have its own 501c3?
(i.e., monthly, bi-monthly, etc.)
Meeting location *
Meeting location
Anticipated Needs for the coming year *
Do you want a free box of prevention brochures?
(100 of each English Brochure – will send to street address indicated above)

Prevention Council Officers


Month & Year
President Preferred Phone Type
President Alternate Phone Type

Vice President

Month & Year
Vice President Preferred Phone Type


Month & Year
Secretary Preferred Phone Type


Month & Year
Treasurer Preferred Phone Type
Please notify PCAIN of any Officer Changes throughout the year

Prevention Council Members

Please provide the names and contact information for other members of your Council who do not serve as officers. We use this list when sending out the Council Courier Enewsletter. Our lists are not shared with other persons/organizations outside of PCAIN. Depending on the number of members, you may need to duplicate this page.

Board Members/Council Volunteers -- Please fill out (emails will only be used to send out Council Courier Newsletter)

Each Chartered Council may receive up to two cases of pinwheels at no charge. Each case contains 240 pinwheels, a total of 480 pinwheels. Please determine whether two cases will work for you.
How many FREE cases of pinwheels does your Prevention Council wish to order for the upcoming year? *

If you need MORE than two cases, each additional case will cost $110 each. If you need more throughout the year, please order them from our shop.

$100 each
Pinwheel Shipping Information *
Pinwheel Shipping Information
How will you pay?