Application for Adoption - Avian

Application for Adoption - Avian

To help ensure the best placement of our animals and to determine that the proposed adoption is in the best interest of the animal, you and your family need to complete each of the following questions. Please be as thorough as possible. PetsConnect! reserves the right to approve or deny any application for adoption.

What is the name of the bird(s) you are looking to adopt? ______

Section 1: Your Information

Name: ______Home Number: ______

Cell Number: ______Email address: ______

Address: ______City: ______State: ____ Zip: ______

Occupation: ______Work Number: ______

Section 2: Co-Applicant Information

Co-Applicant Name: ______Cell Number: ______

Occupation: ______Work Number: ______

How is the co-applicant related to you? __ Spouse __ Roommate __ Other ______

Section 3: Please provide two personal references:

Name / Relationship to you / Phone Number / Email, work phone, or other contact information

Section 4: Household Information

Do you own or rent your home? __ Own __ Rent __ Live with parents

If you rent, landlord or community manager’s name: ______Contact Number: ______Do you have the landlord’s permission to keep a bird? __Yes __No

How many adults live in your home? ____ First names: ______

How many children live in your home? ___ First names and ages of children: ______

Are all members of your household aware that you are applying to adopt this bird? __Yes __ No

Does anyone in your household have asthma or an allergy to birds? __ Yes __ NoIf yes, describe______

Does anyone in your household smoke? __ Yes __ NoIf yes, how many people smoke in the household? ______

Section 5: Pet History

Do you own other pets or birds? __ Yes __ No If no, please proceed to Section 6“Future Pet Information”

Total number of pets/birds in your household ______Are they current on their vaccinations? __ Yes __ No

Are your dogs on heartworm preventative? __ Yes __ No Are your pets on flea preventative? __ Yes __ No

Do your pets have any major health or behavioral issues? __ Yes __No If yes, please describe: ______

Are your pets licensed? __ Yes __No If no, why not? ______

-- OVER --

Please provide the following information about the veterinarian your pets currently see:

Name / Address / Phone

Is this the veterinarian you plan to see with your new bird? __ Yes __ NoIf yes, does this vet have avian experience? __ Yes __ No

If no, please provide the name of your intended avian veterinarian:______

Please provide the following information about the birds/animals living in your household:

Species / Name of Animal / Breed of Animal / Age / Male /
Female / Spayed/
Neutered? / Owned how long?

Section 6: Future Pet Information

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

______

Why are you interested in adoptinga bird? ______

Do you have any experience in keeping birds? __ Yes __ No If yes, what kind of experience and with which species? ______

______

How do you plan to tame this bird? ______

What types of activities do you plan to participate in with this bird for exercise and entertainment? ______

______

Are you aware that exotic birds might have or develop bad habits (destruction of clothing, furniture, drapery, biting, screaming, disliking strangers, disliking a family member, etc.) and that these habits can be difficult to break? __ Yes __ No

\

If your bird develops a bad habit, what will you do? ______

How many hours a day would your bird be home alone? ______How much time will the bird spend out of its cage a day? ______

Where will the bird’s cage be located within the household? ______

How often will you need to change the water? ______How often will you need to feed your new bird? ______

How often will you need to clean its cage? ______What kind of toys will you provide for your bird? ______

Are you prepared to take on the financial burden of a new pet for routine/annual care?

__Yes __No If yes, how much do you anticipate on spending on your new bird a year? $______

Do you currently have an adoption application pending with another shelter/rescue? __Yes __No

Do you object to having a PetsConnect! volunteer visit your home? __ Yes __ No

By my signature below:

I certify that the above information is true and I understand that false information may result in nullifying this adoption.

I understand that you may contact my veterinarian for the vaccination and health history of the pets I currently own or have owned in the past.

I am aware that prior to adopting an animal from PetsConnect!, my currently owned pets must be up-to-date on their vaccinations.

I understand that this application is the property of PetsConnect! and will be retained by them even if I am denied this adoption.

I acknowledge that I understand and agree to abide by the adoption requirements, including the no-refund policy should the placement fail.

Applicant’s signature______Date: ______Time: ______

For office use only:

Rev. 01/10 mmb