Center Valley Animal Rescue
11900 Center Road
Quilcene, WA. 98376
(360) 765-0598
Email: sara@centervalleyanimalrescue.org
Bird Adoption Application
Please e-mail or mail this application when you have finished filling it out.
Bird adoption fees: Small birds - $10 - $30; Parrots - varies
Applicant:
Address:
City:
___________________________________________
Age: ___________
___________________________________________
________________________________ State: ___________
Zip: __________
Hm Phone: ____________________________ Phone (Other): ____________________
Best time to call: _________________________
Email Address: __________________________________________________________
Occupation: ___________________________________________________________
Bird you are interested in (name &/or description):_____________________________
PERSONAL REFERENCES
Name
Daytime Phone
Email
1. ___________________________________________________________________
2. ___________________________________________________________________
3. ___________________________________________________________________
ABOUT MY HOME AND FAMILY
I currently: Own
•
House
there?
• Rent
• Condo
• Live with family/friend
• Apartment
• Mobile Home
How long have you lived
Do you allow smoking in your home?
If you are renting, do you have permission to have a bird?
What is your landlord’s name? ________________________ Phone:__________________
How many adults are in your household?
Children?
List name, age, sex of children:
Any family members allergic to birds?
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Do all family members want to adopt a bird?
If No? Explain:
Any other regular visitors to your home, human or animal that your new bird must get along with?
Describe the activity level of your household:
Zen garden serene
• Moderate activity
• Grand central station
Do you have a secure safe cage?
• Yes: • No:
How will you handle the bird’s exercise needs?
Describe size, type, contents, location of cage.:
Describe the room your bird will be kept in:
Please list animals that currently live with or have lived with in the last 5 years:
Animals Name
1.
2.
3.
4.
5.
Age:
Breed
Spayed/neutered?
Still Own?
If no, what happened?
Do you believe in having wings clipped or in having free flighted birds? (explain):
Do you have a regular avian veterinarian?
• No
• Yes
If yes, Vets Name:
Clinic Name:
Address:
Phone:
Other Veterinarians used in the last 5 years:
MY NEW BIRD
What breed(s) would you like to adopt:
What Gender are you looking for?: • Male
What Age Range?
• Baby
• Female
• Young Adult
• No Preference
• Adult
• Senior
• No Preference
What Size are you looking for? • Small (finch, parakeet, cockatiel) • Medium (Quaker, Conure)
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•Large (Amazon, Grey, Cockatoo) X-Lg Macaw •No Preference
Do you intend to breed your bird?
Explain why or why not:
Are you applying for a bird already in foster? If so, who?
Would you consider adopting a handicapped/special needs bird, explain?
What type of temperament are you looking for?
and Busy • Lots of Energy
• Quiet and Calm
Are you prepared to be pooped on by your new bird?:
• Yes
• Moderately Active Active
• No
What behaviors are you unwilling to work with:
• Quiet • Shy • Submissive • Aloof • Stubborn • Nervous • Energetic • Friendly •
Dominance • Aggression • Cage Protective • Destructive Chewing • Food Throwing • Excessive
Screaming • Escaping • Doesn’t Speak • Doesn’t like a member of your household
If your new bird displays behavior problems, such as biting or screaming, how will you correct
this?
• Contact us • Use a book • Personal Knowledge • Contact your vet • Other Explain:
Have you researched the bird type you are interested in? • Yes
• No
• Not yet
Do you feel comfortable and prepared to answer questions we may ask you about the care of your
bird?
Yes • No • Not yet
LIFE AT HOME FOR MY NEW BIRD
What foods does your current or past birds eat?
What foods will you feed a new bird?
Will your new bird be left at home during the day?
If yes, how long?
Where will your bird be kept while you are not at home? • Loose indoors
Outdoor Aviary • Bird Room • Other:
• Cage indoors
Where will the bird be kept while you are at home?: • Loose indoors • Cage indoors
• On you • Flight cage/aviary • Bird Room • Play Gym • Other:
Where will the bird be kept at night?: • Loose indoors • Cage indoors
• In bed with you • Flight cage/aviary • Bird Room • Play Gym • Other:
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AGREEMENT AND CONSENT
I agree that all of the information that I have provided on this application is true and complete. I
understand that if it is found to be otherwise my application will become void.
I give authorization for Center Valley Animal Rescue, to obtain any information from my veterinarian,
landlord, references that they deem necessary to decide if I am suitable to adopt.
I understand that by submitting this application it is not a guarantee that I will be chosen to adopt. I am
aware that Center Valley Animal Rescue, is located in Quilcene and I may be required to travel there to
pick up my bird.
I am willing to stay in touch with Center Valley Animal Rescue, for follow up on this bird’s welfare. If
for any reason I cannot continue to care for this bird, I agree to contact Center Valley Animal Rescue. I
am not a bird broker or a person looking to make money from the sale of this bird. Center Valley
Animal Rescue, is experienced with applications, interviewing, and home visits so they will work to
find Pets a good home. Center Valley Animal Rescue, appreciates any recommendations for a new
good home. I understand that the adoption fee will not be refunded to me if this adoption is terminated
for any reason.
© Copyright A Place 2 Fledge 2007 – Used by permission with changes made in document.
_______________________________________________________ _______
Application Signature (I agree that my typed name is my signature) Date
_______________________________________________________
_______
Co-applicant Signature (I agree that my typed name is my signature)
Date
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