EmailMe Form - Exotic Bird Adoption Application

Name *

First Last

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country

Home Phone *

### - ### - ####

Cell Phone

### - ### - ####

Work Phone

### - ### - ####

fax

### - ### - ####

Email

What Species of bird are you interested in adopting? Name(s) if applicable: *

Why? *

Your Occupation: *

Spouse/SIG's occupation:

Do all adults in the household know you plan to adopt a bird? *

Yes

No

Are there any children in the household? *

Yes

No

If yes please list names, gender & age:

If no are you planning to have children? *

Yes

No

Does anyone in the household object to adopting this species of animal? *

Yes

No

Type of Home: *

house

condo

apartment

Other

Do you own or rent? *

own

rent

Do you have landlords, homeowners or condo associations permission to keep exotic birds? *

yes

no

N/A

If you or someone else in your household is a smoker, will you be able to provide a smoke-free environment for the bird? *

yes

no

Does anyone in your house burn scented candles? *

yes

no

Do you have and/or use non-stick cookware of any kind? *

yes

no

Does anyone in the household have asthma or allergies? *

yes

no

Are there any other pets (not birds) in the home? *

yes

no

If yes, please list quantity, species and ages:

Are you planning to purchase or adopt any other pets(not birds)?

yes

no

If yes, what species?

Are there any pet birds already in the household? *

yes

no

If yes, what species?

Does anyone in your household have previous experience with exotic birds? *

yes

no

If yes, who and how many years?

Have you owned pets in the past that you no longer have? *

yes

no

If yes, please list what species, how long you had them and why they no longer are with you: (if they died, please list cause)

Have you ever bred birds? *

yes

no

If yes, what species?

Do you currently have an avian vet? *

yes

no

If yes, vet's name, location & phone #:

If you already have birds, have they been vet checked for infectious disease? *

yes

no

N/A

If yes, are they healthy? *

yes

no

N/A

If you already have bird(s) what do you feed them? *

Hold down control button if more than once choice applies

Do you feel qualified to work with special needs birds (i.e.- physical defect or psychological problems)? *

yes

no

If yes, please explain qualifications: *

What would you do if your bird came to you with or developed bad habits? *

Do you feel you are financially able to provide for the animal you wish to adopt, in terms of veterinarian costs, food, housing, toys, etc? *

yes

no

How much would you budget annually to care for this animal? *

Are you willing to keep your home at a temperature that suits the needs of your bird whether or not you are at home *

yes

no

What temperature do you normally keep your home thermostat set to in the winter? *

Summer? *

Spring? *

fall? *

Are you aware that animals can carry diseases which could be transmitted to humans? *

yes

no

Do you know that exotic birds NEED a lot of attention and care and that behavioral modification can take years of patience to achieve? *

yes

no

Do you know that exotic birds are capable of biting, screaming and destroying property and that they tend to be very messy in terms of droppings and food splattering? *

yes

no

Are you prepared to put in the effort to keep the cage clean, the food and water fresh and to work with the animal consistently and patiently on a daily basis to build a relationship of trust and companionship? *

yes

no

Why are you interested in adopting rather than purchasing a companion bird? *

Under what circumstances would you not be able to keep the bird? *

Have you done any prior research on the care an behavior of exotic birds? *

yes

no

If no are you willing to do the research prior to adoption? *

yes

no

Do you have a suitable cage available for your new bird? *

yes

no

Where do you plan to locate the bird's cage? *

If you already have birds do you have a quarantine area available for the bird? *

yes

no

If yes, where? *

How much time will the primary caregiver have available to spend with the bird on a daily basis? *

How many hours per weekday will the bird spend alone (without human companionship) in your home? *

Weekends? *

How much daily "out of cage" time do you expect to be able to provide for the animal for exercise and interaction? *

Who would care for your bird if you went on vacation or fell ill? *

Would you object to an inspection of your home, before and after the adoption by Majical Miniatures? *

yes

no

Is there anything else you would like to say regarding your desire or qualifications to adopt this species of animal?

How did you hear about us?

Date Time

MM / DD / YYYY

Signature: *

Donation Fee: *