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Cowboy Capital Pet Assistance League

Bandera, Texas

This questionnaire assists us in making the best possible match between adopter and dog.  We believe that all of the information requested is relevant to the success of the adoption process.  Please answer every question.  C.C.P.A.L. does not place pets to be given as gifts to others.

After filling out form please e-mail to Marlene Heavener at maudrey@aol.com

DATE:

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NAME:

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ADDRESS:  

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STATE:

ZIP CODE:

CITY:

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HOME PHONE NUMBER:

HOW LONG?

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WORK PHONE NUMBER:

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CELL NUMBER:

List all animals you have had in the last 10 years, and what has happened to them:

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Do you currently own any pets?  If yes, please list, breed / size, number of years owned, age, sex, altered, current on vaccinations  and type of Heartworm Preventative:

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Rent?

Do you own your home?

House, Condo, Duplex, Mobile/Court:

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Name of Landlord:

Landlords Phone Number:

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Will anyone be home during the day?

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Who?

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Do you have Children?

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List the Ages of your Children:

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Does anyone in your household have allergies to animals?

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Where will this pet spend most of its time?

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How much time will you per pay with the pet?

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Are you willing to take this pet to an obedience class?

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Do you have a yard?

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Is it fenced?

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Type of Fencing:

If the yard is not fenced, what type of confinement do you plan to provide?

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If you ever move, what will happen to this pet?

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Are you familiar with the local animal control ordinances in the area in which you reside?

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Will this pet be on heartworm preventative?

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If not, why not?

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Name of Veterinarian Clinic:

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Name(s) of pets this vet has seen for you:

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By submitting this application, I hearby certify that the information on this application is true.

Signed:

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Date:

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