ANNUAL SHELTER SURVEY
2000-2001

SECTION 1: OPERATING STATISTICS

SHELTER/GROUP NAME: __________________________________

Please fill in the following satistics (approximations are fine) for the 1 year of operations from January 1 to December 31, 2000 or if different please state for what period your figures refer : ________________ to _________:

Total animals taken in: __________

Total animals adopted out: _______

Total animals Euthanized: ____________

Total LOST animals reunited with owners: _____________

Total animals Sterilized: ____________

Total number of employees: ______________ full + part-time (paid)  

Total number of workers: _________________full + part-time (volunteer)

Total $ expenditures overall:  $______________

Total of PRIVATE $ donations received: $______________ (if any)

Total of Government $ funds received:  $________________ (if any)

SECTION II: FEE SCHEDULE
1. Animal registration fee:  Sterilized:$__________  Non-Sterilized $___________

2. Animal Pick-up fee: $________________

3. Microchip: $_________________  Registration fee:$ _______ 
2. Feline Vaccinations:
 Rabies and Tag: _$___________
 Feline Leukemia: $_______
 Anti-virus (Rinotraqueitis,Panleucopenia, calicivirus etc) $_______

3. Canine Vaccinations:
 Rabies and tag: $_________
 Anti-virus (Parvo,Influenza,Distemper, lepto etc): $________

4. Sterilization:
 Cat, male: $__________
 Cat, Female: $________
 Male dog: <20 lbs $_______; 21-40 lbs $_______; > 40 lbs $______
 Female dog:<20 lbs $_____ ;21-40 lbs $_______; > 40 lbs $______
 
5. Pre-surgery check-up:
 Dog $__________ Cat $ _________

6. Health Certificate:
 Dog $__________ Cat $ _________

7. Euthanasia (incl. disposition):
 Cat $ ______; Dog <40 lbs $__________; Dog > 40 lbs $________
8. Cadavre disposition:
 Cat $ ______; Dog <40 lbs $__________; Dog > 40 lbs $________

8. Laboratory Tests:
 Heartworm: $____________; Feline Leukemia $_________; CBC $_______
 Fecal $________; Blood Chemistry: $__________
SECTION III:  Operating data

Government:   yes_____        Private: yes______ 

Incorporated: _______  Non-profit:________  Tax Exempt: __________

Drugs and Controlled Substances License: _______

Open to public:  NO _____   
   YES ________ Operating hours: ___________________
         _________________
         _________________
Animals handled: Dogs ____Cats ___  Horses ___ Birds____Other:_____

# of Dog Runs: _______ # of dog cages: ______ # of Cat cages: ________

Veterinarian :  Full time: ___________
   Part time: ___________ days per week: ____
   As needed: _____

Pick-up service: __________

Services offered:

 Education _____    Spay Day ______  Vaccinations_______
 Adoption_______    Rescue _______  Investigation _______
 Pick-up ________   Boarding ______  Sterilization________
 Euthanasia _________ Grooming _________ Incineration ________
 Lost/Found _______  Other: _______________________________

Member of: AHA___ HSUS __ PETA __ ASPCA ___NACA___API____