xxx Adoption Application (old) xxx

Our contract requires that if you cannot keep the bird for any reason, you MUST return the bird to our program. Do you agree to this requirement? *

Adoptable Animals

Species Interested: List All Interested *

How did you find out about us? *

Section 1 - Contact Information

First Name *

Last Name *

Street Address *

City *

State *

Zip Code *

Phone Number *

Email Address *

Alternate Phone Number

Date of Birth *

What is the best way to reach you?

Section 2 - Residential Information

Type of Residence

Do you own or rent your home?

How long have you lived at this address?

If you rent or lease, does your landlord and lease allow pets?

Please Provide Landlord Contact Information

Does anyone who resides in or visits your home smoke or use nicotine products?

Section 3 - Family Demographics

Including yourself, how many people live in your household?

Please list the names, ages & relationship of those who live in your home. (Please Include Yourself)

Will you allow us to perform a homecheck?

Will you allow us to perform a background check on all adults over the age of 18?

Does anyone in your home have asthma or allergies?

Do you use nonstick coated cookware?

Section 4 - Bird Knowledge

Please give us a details about any bird experience that you may have?

Are you aware that exotic birds could potentially carry diseases that could affect humans?

Did you know that it isn't safe to use scented plug-ins, air fresheners, candles or etc. around a bird?

Section 5 - Employment Information

Employment Status

If you are employed, what is your current occupation, name of employer, and address?

Section 6 - Potential Bird Information

Why are you interested in adopting a STAR bird?

What are the most important characteristic you are looking for in a bird?

Are you aware the birds might have or could develop habits that could cause injury to people or damage property?

Will you leave your TV, radio, or some other audio/video on for your bird?

How often will you clean and disinfect the cage?

How much time outside of the cage will your bird spend for exercise and entertainment?

How much time will your bird spend alone?

What will you feed your bird?

Describe how you will bath your bird.

How will you handle this destructive behavior if developed?

Would you be willing to attend a class on basic bird care if available?

Section 7 - Current Bird Information

Have you ever had birds?

If you no longer have these birds, what happened to them?

Please list any birds you have. (Name, Species, Age, How long you have had this bird., Date of last vet visit.)

Who is/ will be the caregiver for the birds?

When you go on vacation, who does/ will care for your bird(s)?

Do you currently have an avian veterinarian? If yes please provide information. (Clinic's Name, Vet's Name, Address, City, State, Zip Code, Phone Number)

How often do you/ will you take your bird to the vet?

Section 8 - Current Other Pet Information

Do you currently have any other pets besides birds?

Please list any other current animals you have with the following information

Name

Species/Breed

Age

Spayed/Neutered

De-Clawed

Indoor or Outdoor

How long have you have this animal?

Date of the last vet visit

Please List Above Information About Animals

Have you ever had any animals that you no longer have? Please explain the reason why.

Section 9 - Veterinarian Information

Veterinarian's Name

Veterinarian's Address, City, State, and Zip Code

Veterinarian's Phone Number

VETERINARY INFORMATION RELEASE:

I hereby authorize the release of ALL medical records pertaining to the listed animal(s) to representatives of St. Louis Avian Rescue (STAR).

PLEASE READ CAREFULLY.

This is not meant to intimidate you nor to cast a negative light on exotic birds. Rescued birds are no more and no less likely to behave in an aggressive or unpredictable manner than any others. But, Saint Louis Avian Rescue wants to make you aware of possibilities when working with them.

The birds that Saint Louis Avian Rescue place have been surrendered, abandoned, or in some way displaced. They may have been abused or neglected. There may only be limited information available regarding their previous environment. S.T.A.R. will share with you what information we have. There will be an adjustment period. Remember to be patient, consistent, and understanding.

Avian medicine is a relatively new discipline. It is possible for a bird to be a carrier of, or infected with, a disease that is undetectable with the current tests and tools available today. Therefore, you should quarantine any bird new to your flock. We recommend a period of at least 30 days – 90 would be even better.

If a bird is placed with you, you will be responsible for providing appropriate food, water, and loving attention. Many parrots have an extremely long life expectancy. Please think carefully about this. Are you ready to make this commitment?

I certify that I have never been charged with nor convicted of animal abuse or neglect in Missouri or any other state. I certify that no one in the household where this bird would reside has been charged with nor convicted of animal abuse or neglect in Missouri or any other state.

Please Initial:

I certify that any bird adopted will NOT be placed into a breeding situation. I certify that should I not be able to or not want to properly care for this bird, or in the event of my death, the bird will be returned to St. Louis Avian Rescue. *

I have read the foregoing and certify that the answers I have given are complete, true and not misleading in any way. I am authorizing you to contact landlords, associations and veterinarians. You are also aware that we cannot guarantee the health and temperament of the animal. *

Signature Instructions:

Use your mouse to sign your name by clicking and holding it down as you write if not using a touchscreen device.

Signature *