Owner Wishes and Emergency Information

*** This is NOT a legal document ***

*** Please consult with your attorney for all estate planning questions ***

At EBR, we believe that exotic birds make great companions, but also recognize many birds will outlive their owners, and can pose additional concern during emergency situations. We appreciate that you are taking the time to plan ahead in the event you are no longer able to care for your bird.

We will keep a copy of this form on file, but we also recommend that you share it with your attorney, family or friends, as well as keep a copy somewhere easily accessible in an emergency situation.

First Name *
Last Name *
Email *
Phone Number *
Street Address *
City *
State *
Zip Code *
Bird's Identification
Bird's Name *
Species *
Subspecies
Color *
Do you know the bird's exact hatch date?
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Exact Hatch Date
Estimated Hatch Date
Sex *
Sex determined by: *
Please provide photos of the bird.
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Is this bird banded? *
Band description and number: * Band description and number:
If possible, please provide a photo of the band:
Is this bird chipped? *
Chip information: *
Where did you get this bird? *
How long have you had the bird? *
Previous owners' contact information (if known)
Cage and Housing Information
Cage size:
Cage type:
Please provide a photo of the cage.
Types of perches in cage:
Number of perches:
Type of toys:
Number of toys:
Favorite Toys:
Cage is lined with:
How often is cage cleaned?
How is the cage cleaned?
What room is the cage located in?
What is the activity level of the home?
Is cage placed near any of the following? *
Does the bird have any of the following?
Routines
At night the cage is covered with: *
How many hours a day is the bird usually out of its cage?
How often is the bird alone?
When does the bird wake up/lights on?
When does the bird go to bed/lights out?
How does your bird bathe? How often? *
Is there anything else we should know about the birds housing or routine?
Dietary Information
Please describe your birds dietary routine. Include what and when you feed the bird. Include vegetables, fruits, nuts, pellets/seeds (including brand) and treats. *
What is their favorite food? *
What type of water do you use for the bird? *
Behaviors and Preferences
Is this bird able to fly? *
Is this bird used to being toweled? *
Is this bird step-up trained? *
Is this bird target or clicker trained?
Is this bird harness trained?
Bird's vocabulary and tricks, if any:
Has this bird been allowed on shoulders?
Does this bird get along with men? *
Does this bird get along with women? *
Does this bird get along with children? *
Does this bird get along with dogs? *
Does this bird get along with cats? *
Does this bird get along with other small animals? * Unknown, or has not been around \| Comfortable \| Tolerates \| Aggressive \| Fearful
What are the bird's best qualities? *
What are this bird's biggest challenges? *
Does this bird have any phobias we should be aware of?
Health
Has this bird seen a vet? *
Name of Veterinary Practice:
When was this bird's last vet visit? *
What was your bird last seen at the vet for?
Does this bird have any known health issues (including feather destruction)? If so, please describe. *
This bird has had the following diagnostic tests: *
This bird has been exposed to: *
Was this bird ever used for breeding? *
Does this bird have any offspring? If so, how many? *
When was the last time this bird laid an egg?
Is there any other information that you feel is important to share with future caretakers of this bird? *
Emergency Contact Information In the event of an emergency, please contact the following people to care for my bird.
Primary Emergency Contact
Name
Phone
Email
Address
Relationship
Secondary Emergency Contact
Name
Phone Number
Email
Address
Relationship
Attorney or Legal Representative
Name
Phone Number
Email
Address
In the event none of my emergency contacts are able to care for my bird in an emergency situation, or upon my death, please contact Exotic Bird Rescue of Oregon. I understand that Exotic Bird Rescue of Oregon may rehome my bird if other arrangements are not made. EBR cannot guarantee intake of my bird. *
I understand that the care of an exotic bird is expensive and would like to donate to help defer costs. I would like my estate to donate the following assets to EBR if my bird is placed in their care:
I give permission for Exotic Bird Rescue of Oregon to contact my Emergency Contacts and/or Attorney in the event they are contacted first by law enforcement, emergency medical services, hospice, or an equivalent representative. *	Yes - Emergency Contact and/or Attorney Yes - Emergency Contact only Yes - Attorney only No - I do not give permission
I would like my Emergency Contacts and/or Exotic Bird Rescue to take ownership and care of my bird in the event I am unable to care for them any longer, whether due to emergency or death. Please keep my bird's belongings (cage, dishes, playstand and toys) with them to help make the transition into a new home easier. After an emergency situation where the bird is returned to me, I agree to reimburse Exotic Bird Rescue for reasonable expenses of caring for the Bird, such as veterinary care, food, toys, boarding, and overhead expenses. Exotic Bird Rescue is a 501(c)3 non-profit corporation dedicated to the rescue, rehabilitation and health of exotic birds through education, research and service.
*	EBR recommends I consult with my attorney for any estate planning or legal questions.
Signature *
Date *

Exotic Bird Rescue is a 501(c)3 non-profit corporation