First Name*

Last Name*

Address

City

State/Province

Zip/Postal Code
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Email*

Home Phone

Work Phone
x

Cell Phone

Alt Email

Text/Pager Email

Which animal are you interested in adopting?
Choose an animal: Suki

Why are you interested in adopting a pet at this time*

Do you have any birds now?*
Choose one: No Yes

If you currently own birds, please list how many and their species.*

Have you taken care of birds in the past that you no longer have? If so, what species and where are they now?*

Name and Address of your employer: (indicate N/A if no employer)*

Spouse or partner employed?*
Choose one: full time part time Unemployed Retired no spouse or significant other

Name and Address of spouse/partner's employer: (indicate N/A if spouse/partner is not employed:*

Do all the adults in your household know that you are applying to adopt a bird?*
Choose one: No Yes

Ages of all children living in household:*

How much time will the animal spend alone during the day*

When you are away on a trip who will care for the dog?*

In what type of home do you live*
Choose one: Single Family Duplex Apartment Townhouse Condominium Mobile Home Military Housing

Do you own or rent your home*
Choose one: Rent Own

If you rent, have you received the approval of your landlord to have an animal
Choose one: No Yes

If you rent, please enter your landlord's name and phone number

Do you or anyone in your household smoke?*
Choose one: No Yes

If yes, would you be able to provide a smoke free environment for this bird? m Please explain.*

What other animals are currently in your household? Specify species, breed and ages. *

If you have other birds, do you have a separate quarantine area for new birds (a separate room with a door that can close)? Please describe.*

Are your current birds wings clipped?*
Choose one: Yes No N/A

How do you/would you discipline your bird? Be specific.*

What do you/would you feed your bird? Where would you buy it? Be specific.*

Do you/would you let your bird out of the cage daily? If so, for how long, on average?*

If so, where would they be when out of the cage?*

What would you do if you came home one day and found your bird on the bottom of the cage, obviously ill?*

Are you aware that exotic birds may devleop or have bad habits such as destruction of clothing, furniture, draperies or anything within reach, biting, screaming, dislike of strangers or your mate, leaving droppings everywhere and that these habits can be difficult to break? Also that they require a great deal of attention and maintenance and that they can be expensive to keep fed, healthy, housed and entertained?*
Choose one: No Yes

If the bird does have or develop a bad habit, what would you do?*

Would you like to have this bird for breeding purposes?*
Choose one: No Yes

Are you planning on keeping your adopted bird in an aviary situation?*
Choose one: No Yes

Are you aware that bird medicine can be very expensive?*
Choose one: No Yes

If your bird does become sick, do you you have the resources to get it proper care? If so, please explain. *

Do you have or know an avian veterinarian? If so, who, what hospital and city? Please provide phone number.*

Current Veterinarian's Name and Phone Number, if different from above:*

Some species of parrots can live for many years. Would you have a plan in place in case your death preceded the death of your parrot? Please explain.*

Under what circumstances would you NOT wish to keep the bird? (Check all that apply):

How important are these characteristics in a bird? Check all that apply.

Please add any other comments, concerns, or questions you might have.

I certify that the information entered on this applicant is true. Enter your name and date*