Are you able to provide executorship documentation and/or copy of Trust that allows you to turn the bird over to STAR?
No Yes
Date: *
Contact Information
First Name *
Last Name *
Address *
City *
State *
Zip Code *
Phone Number *
Email *
Are you filling this form out on behalf of another person? *
Yes
No
If yes, please explain:
Please note, the surrendering owner may be required to sign a release of rights at time of transfer.
Bird Information
Please be as truthful about any issues as possible. Behavior and/or medical issues will have no bearing on bringing a bird into our foster program. More information will allow our team to ensure proper placement is made within our foster homes and will allow our team to be able to offer any potential advice to managing any issues until we are able to bring them into our program.
Bird's Name *
Species *
African Grey
Amazon
Caique
Canary
Cockatiel
Cockatoo
Conure
Dove
Eclectus
Finch
Indian Ringneck
Lorikeet
Lovebird
Macaw
Mini Macaw
Parakeet
Parrotlet
Pigeon
Pionus
Poicephalus
Quaker (Monk Parakeet)
Unknown/Other - Large
Unknown/Other - Medium
Unknown/Other - Small
Unknown/Other - X-Large
x Foster Applicant x
x Volunteer Applicant x
Subspecies or coloring *
Alexandrian
Bare Eyed
Black Capped
Blue and Gold
Blue Crown
Blue Front
Blue Head
Blue Throated
Bourke's
Brown Headed
Budgie
Buffon's*
Caique
Canary
Cape
Citron
Cockatiel
Congo
Crimson Belly
Diamond
Double Yellow Head
Dove
Dusky
Dusky
Eclectus
Finch
Fischer's
Goffin's
Gold Cap
Golden
Gouldian
Greater Sulfur
Greencheek
Greenwing
Grey
Hahn's
Harlequin
High Red Factor
Hyacinth
Hybrid Catalina
Hybrid Ruby
Illiger's
Indian Ringneck
Jardine's
Jenday
Lesser Sulfur*
Lilac Crowned
Lineolated
Lorikeet
Lovebird
Lutino
Maroonbelly
Masked
Maximillian
Mealy
Mexican Red Head
Meyer's
Military*
Moluccan
Moustachioed
Nanday
Noble
Orange Front
Orange Wing
Palm
Parrotlet
Peachface
Pied
Pigeon
Pineapple Greencheek
Princess of Wales
Quaker Parrot
Rainbow
Red Front
Red Fronted
Red Lored
Red Shouldered
Ringneck
Rose Breasted (Galah)
Scarlet*
Senegal
Severe
Society
Sun
Timneh
Umbrella
Unknown - Large
Unknown - Medium
Unknown - Small
White Cap
White Eyed
Whiteface
Yellow Collar
Yellow Front
Yellow Nape
Zebra
zzzAdminUsezzz
Age (Hatch Date if known) *
Check if age is a guess or estimate:
Sex
Female
Male
Unknown
If known: How and when was the sex verified
If known: How and when was the sex verified
When did you acquire the bird? *
Where did you acquire the bird? *
Adopted from STAR
Pet Store
Private Breeder
Animal Shelter
Friend or Family
Bird Club
Private Party
Gift
Found
Other
If other, please explain
What is the bird’s history? (previous owners, reason for previous rehoming …etc):
Current Diet
Please be as specific as possible.
Current Diet- include brand and type (seed or pellet ...etc.): *
Does the bird eat fresh fruits/vegetables (or other "people" food)? If so, regularity and favorites?:
Does the bird have favorite treats or foods?
Are there any foods that the bird dislikes or has a negative reaction to?
Do you have vitamin supplements?
Yes
No
If yes, please describe:
Any other notes/details regarding diet:
Medical History
Do you currently have an avian veterinarian? *
Yes
No
Clinic's Name
Address
City, State, Zip Code
Phone Number:
How often do you take the bird to the vet?
When was the bird's last vet visit?
What was the reason for this visit?
Is the bird banded?
Yes
No
If yes, what is the number?
Is the bird micro-chipped?
Yes
No
If yes, what is the brand?
Describe the bird's overall physical condition/health: *
Has the bird ever sustained any injuries?
Yes
No
If yes, please describe:
Has the bird ever had surgery?
Yes
No
If yes, please describe (reason, where surgery was performed ...etc):
Has the bird ever been treated for any diseases/illnesses?
Yes
No
If yes, please describe:
Has the bird ever taken any medications?
Yes
No
If yes, please list and give reason for medication and any other details (still taking them, dosage ...etc)
Has the bird ever been on herbal or other alternative therapies?
Yes
No
If yes, please describe:
Any additional comments/information regarding the bird’s health history:
Routine Care
Who is the bird's primary caregiver?
Cage:
Please describe the bird’s current cage and cage set-up: * *
What type of perches and/or toys does the bird prefer?:
Photo of current cage:
Are you planning to donate the cage with the bird?
Yes
No
Daily Care:
Describe the bird’s sleeping habits (bedtime, wake-up time, hours of sleep …etc.): *
Do you cover the bird’s cage at night?:
Yes
No
Does the bird have a history of night frights or other sleeping issues?:
Describe the bird’s bathing habits (frequency, likes/dislikes):
How much time does the bird spend outside of the cage each day?:
Please describe the bird’s play areas:
Does the bird have any favorite games or activities?:
How much time does the bird spend alone?:
Do you leave the radio, TV or other audio/video on for the bird?:
Any additional comments/information regarding the bird's daily routine/care:
Behavioral Information
Is the bird hand tame? *
Yes
No
Sort of
Does the bird have any known behavioral problems (i.e. screaming, plucking, aggression, etc.)? *
Yes
No
Please be honest. Known issues will not prevent us from bringing in a bird, but will help us in understanding their behavior and will enable us to provide the best placement situation as possible.
Please describe (please be as descriptive as possible):
Has the bird been around other birds/animals?: Yes/No
Yes
No
Please describe (i.e. enjoys company of other birds, is frighted of dogs …etc.):
Who is the bird’s favorite person?
How does the bird interact/react to others (strangers, others in household, children …etc.)?:
Why do you feel surrender of the bird is the best option?: * *
Would assistance with education or behavior modification be a possibility as a means for you to keep the bird?: *
Yes
No
How did you learn about STAR - St. Louis Avian Rescue? *
Event
Petfinder
Internet Search
Family/Friend
Staff/Volunteer
Social Media
Former STAR bird
Other
Additional comments or information you would like to share:
Optional: Provide a photo of your bird(s)
Optional additional photo
Do you have veterinary, adoption, hatch or other records (i.e. DNA certificates) that you would be willing to share with us?:
Yes
No
If yes: Please upload a copy below (if image file) or email copies (at your convenience) to records@staravian.org (with the name and species of the bird). If you are not able to upload or email, a paper copy may be given to a STAR representative at the time of intake.
Optional: Copy of Medical or other records
Optional: Copy of Medical or other records
Optional: Copy of Medical or other records
If you are donating a cage or other supplies, please include details and photos below. Please note, donation of cage/supplies does not affect the decision to bring birds into our program, but these details do assist in coordination of intake.
Optional: Photo of Cage and/or Supplies
Optional: Photo of Cage and/or Supplies
Optional: Photo of Cage and/or Supplies
Would you be interested in making a donation to STAR to assist in covering veterinary and other costs incurred by the bird while in foster care?:
Yes
No
Thank you. Donations may be made via cash/check at time of intake, or virtually via PayPal, Venmo, CashApp or Credit Card. If you have any questions, a member of the Intake Team will be able to assist you.
While we do not require a fee for placement into our program, as a nonprofit that runs off of donations, it is always appreciated. STAR is a 501c3 non-profit and all donations are tax deductible.
Veterinary & Rights Release
Are you the legal owner of the bird(s) being surrendered?
No Yes
Is the owner is recently deceased? *
No Yes
Are you able to provide executorship documentation and/or copy of Trust that allows you to turn the bird over to STAR? *
No Yes
By signing below, I understand the following:
I understand that I am relinquishing the aforementioned bird(s) to STAR - St Louis Avian Rescue Inc ("STAR") and I agree that STAR shall have legal possession and ownership over the bird(s). I relinquish all claims to the above listed bird(s) at the time of transfer.
I understand that this transfer of ownership will not take effect until the physical transfer of the bird into the possession of a STAR representative.
I further understand and acknowledge that I will not be contacted regarding the bird(s) being adopted nor will I be provided with information about the adoptive home.
I understand that any updates on the bird(s) after they have been surrendered will be given at the discretion of STAR - St Louis Avian Rescue Inc. I further certify that STAR St Louis Avian Rescue Inc may choose to keep all information regarding the status of the bird private.
I understand that if I want the bird(s) returned to me, that I will be required to apply for the bird and pay any adoption fees and/or incurred vet fees associated with them. I also understand that I may be denied the return of the bird.
I hereby authorize the release of ALL veterinary medical records to representatives of STAR - St Louis Avian Rescue Inc for the aforementioned bird(s).
All information listed above is true and accurate to the best of my knowledge.
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 *
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