Do you currently have a pet?       Yes No

If Yes, Section 1                                         If No, Section 2

Section 1

Type Pets?    Cats?  How Many?  None 1 2 3 4 5 or More

                                 Ages:                   

                      Dogs?  How Many  None 1 2 3 4 5 or More

                                 Ages:                   

Are all pets spayed/neutered?      Yes No

         If no, select reason(s):         Financial Transportation Other

Do your pets get annual vaccinations?  Yes No

         If no, select reason(s):         Financial Transportation Other

Monthly Expenses:

Pet Food:      $        

Cat Litter:     $        

Veterinary:    $        

Proceed to Section 3

Section 2

Are you interested in having a companion pet?   Yes No

          If yes, reason(s) you do not have a pet:     Financial Not Allowed Other

Proceed to Section 3

Section 3

Interested in volunteering @ local animal shelter?    Yes No

          If no, select reason(s):       Financial Transportation Other

Please provide us with ideas to assist you and your friends with companion animals:

Do you and your friends have a regular social gathering (e.g. bingo) that may enjoy a visit from an animal related organization (e.g. Therapy Dogs)?        Yes No

           If yes, please provide contact information: 

                  Name:           

                  Phone:          

                  e-mail:          

Please tell us how to contact you: 

                  Name:           

                  Phone:          

                  e-mail:          

^{* All completed questionnaires received will be entered in a drawing for a $25.00 Gift Certificate.  You must complete the entire questionnaire and provide your full contact information to be entered into the drawing.}