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

BIRD INFORMATION

Bird's Name*

Species

Do you wish to surrender or rehome your bird?*

I hereby authorize the release of medical records pertaining to the above listed bird(s) to representatives of For The Love of Birds. Please initial and date.*

IF YOU WISH TO SURRENDER A BIRD, PLEASE COMPLETE THIS QUESTION:

I hereby donate to For The Love of Birds, the above listed bird(s) to be placed in foster care for adoption out to a loving private home. I relinquish all rights and claims to the above mentioned animal. I attest that I am the legal owner of said animal, that I have the right to place it, and I am signing this agreement of my own free will and not under duress of any kind. I state that no other person has any legal or financial claim to said animal. I also state that the bird was captive bred/ domestic bred or they were in captivity prior to December 10, 1991, and obtained legally. By signing this document, I have read and understand the foregoing and agree that all parts and portions constitute a legal and binding contract. I also further state that all statements made by me are true to the best of my knowledge. To ensure the health of all birds in our care, we require testing on all birds surrendered to FTLOB for Chlamydia and PBFD, for a fee of $30 per bird, or cage of birds (Chlamydia testing only for Finches, Canaries, and Doves for $24.50 per bird, or cage of birds). This fee is payable by you directly to Animal Genetics if you send in your bird's test sample or to FTLOB upon surrender of the bird(s) if the rescue performs the testing. Parrots under 1 year of age will also be testing for Polyoma, the fee for the 3 tests is $45. This fee will be waived (with proper documentation) if you have already had this testing performed. In addition, to help offset costs incurred while the bird(s) are in foster care (food, enrichment, vet care, etc.), additional donations are accepted and greatly appreciated. Please type full name and date:

IF YOU NEED HELP WITH REHOMING, PLEASE COMPLETE THIS QUESTION:

I hereby request the help of For The Love of Birds to assist me in finding a new home for my bird(s). I also state that the bird was captive bred/ domestic bred or they were in captivity prior to December 10, 1991, and obtained legally. I will continue to care for my bird(s) until a new suitable home is found. I will have a disease test performed on the bird for chlamydia and polyoma and will forward test results to For The Love of Birds. FTLOB will forward approved adoption applications to me for consideration. I will follow For The Love of Birds protocol to schedule multiple visits depending on the species. The choice of adopter will be under my sole discretion and I will not hold for the Love of Birds responsible for any applicant I may choose. As is suggested by FTLOB, I will ask for an adoption fee that is equal to or less than that that would be required by For The Love of Birds. I will donate 50% of the adoption fee to For The Love of Birds. I agree to assist FTLOB in posting my bird online including providing photos and a write up. Please type full name and date:

Why are you considering placement of your bird with For The Love of Birds? Please let us know time frame or urgency of situation. *

Age and sex (if known)

Band No.

Is your bird microchipped?*

If yes, what brand:

Where did you acquire your bird?*
Choose one: Animal shelter Bird club Breeder Family/friend Gift Other Pet store Private party

Other: please specify:

Please provide contact information for your bird's breeder, pet shop, or previous owner (please include name, store/business name, full address, phone and email):

VETERINARY INFORMATION

Do you currently have an avian veterinarian? *

If yes, please provide contact information including vet name, clinic name, full clinic address, phone and email:

How often do you take your bird to the vet?*

When was your bird's last visit?

What was the reason for this visit?

Describe your bird’s overall physical condition:*

Has your bird been tested for disease?*

If yes, when and where?

Has your bird ever sustained any injuries? If yes, please describe:*

Does your bird have any physical deformities? If yes, please describe:*

Has your bird ever had any surgeries? If yes, please describe and give reason(s):*

Has your bird ever been treated for any diseases? If yes, please describe:*

Has your bird ever taken any medications? If yes, please list and give reason(s):*

Does your bird have any medical/physical condition that requires treatment and/or a specialized caging/play area? If yes, please describe:*

CURRENT DIET

Describe your bird’s current daily diet; include feeding times:*

List the foods your bird currently eats, including specific food names and brands:

Fruits:

Grains/pasta:

Nuts:

Pellets:

Seed mix:

Sprouts:

Treats:

Veggies:

Do you use vitamin supplements? If yes, how do you give them?*

ROUTINE CARE

Describe your bird's cage, including size, brand and model (if known). Also describe the room the cage is located in.*

Will you be surrendering the cage and supplies?*

Does your bird use a separate sleeping cage?*

Do you cover your bird’s cage at night? *

Describe your bird’s favorite toys:*

How many hours a day is your bird used to being out of his cage? *

Describe your bird’s bathing habits, including frequency, likes and dislikes:*

Do you leave the radio, TV, or other audio/video on for your bird during the day?*

BEHAVIOR

Is your bird hand tame?*

Is your bird flighted? If yes, please describe your bird's flying ability:*

Describe your bird’s playtime activities:*

Does your bird get along with other birds? Please explain:*

Does your bird get along with other family pets such as dog and cats? Please explain:*

Please list all other animals that live on your property including chickens, waterfowl, pigs, horses, etc.

Would your bird do well in a family with young children? Please explain:*

Would your bird do well in a family with a hectic and loud environment? *

Has your bird exhibited a preference to men or women? Please explain:*

Does your bird ever have night frights? *

Has your bird ever laid an egg ? Describe details .

Is your bird Loud ? Does He/She scream ? If yes what are the triggers ? When did you notice that it started ? What do you try to do to calm your bird?

Does your bird bite? If yes, under what conditions?*

Is your bird destructive? Please explain:*

Does your bird show signs of aggression? If yes, please explain:*

Does your bird pluck?*

Does your bird mutilate?*

Would assistance with education or behavior modification be a possibility as a means for you to keep your bird? *

How did you learn about For The Love of Birds?

Is there any additional information that you would like us to know?

For The Love of Birds is dedicated to making sure we do what is best for your bird. We will always take into consideration any special comments left by an owner who releases a bird into our care. We know and understand that placing a companion bird is never an easy task and we try to make this an easy transition for everyone. We request that a donation be made to For The Love of Birds at time of surrender to help us pay for disease testing, medical exam, food and other supplies. However, no bird will be turned away due to inability to make a donation. Please type full name and date:*