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Sample Shelter Forms

Bird Adoption Application

Monica Engebretson and Eileen McCarth

Bird Adoption Application*

Taking care of a bird is a serious responsibility. This adoption application is designed to help you decide if a bird is the right companion for you, and to ensure that you are properly informed about the needs of captive birds. Before completing this application, please read the provided information. You must be at least 18 years of age to adopt a bird from this shelter. This application is confidential.**

Name________________________________________________

Address______________________________________________

City__________________ State______ Zip Code____________

Phone # ____________________________

Email (optional)_______________________

1) Type of residence? House__ Condo__ Apt__ Other___

2) Do you rent__ own__?

3) If you rent, do you have the landlord's consent to have a bird? No __Yes__

4) Do all parties in your household know that you are applying to adopt a bird? No__ Yes__

5) Are you aware that exotic birds may carry diseases that can infect humans? No__ Yes__

6) Does anyone in the household have allergies or asthma? No__ Yes__

7) Does anyone in the house smoke? No__ Yes__

8) Who will be the primary caretaker of the bird? ___________________________________

9) Who will care for the bird when the primary caretaker is away, either for business or vacation? ______________________________________________________

10) Approximately how much time will the responsible person have available to spend with the bird?
Weekdays_____________________________________________________
Weekday evenings______________________________________________
Weekends_____________________________________________________

11) How many hours a day would the bird be left alone?____________________

12) How will you provide daily exercise and entertainment for your bird? __________________ ______________________________________________________________________________

13) Why are you interested in adopting a bird________________________________________ _____________________________________________________________________________

14) What are the most important characteristics you are looking for in a bird?________________
______________________________________________________________________________

15) What do you feed an exotic bird? _______________________________________________

16) Do you have any experience in keeping birds? No__ Yes__ If so, what?_______________ ______________________________________________________________________________

17) Would you be willing to attend a class on bird care if available? No__ Yes__

18) Do you know an avian veterinarian? No__ Yes__

19) Would you like us to recommend an avian veterinarian? No__ Yes__

20) Are you aware that exotic birds might have or develop bad habits (destruction of clothing, furniture, drapery, etc; biting; screaming; dislike of strangers or certain household members; leaving droppings everywhere), and that these habits can be difficult to break? No__ Yes__

21) If your bird develops a bad habit what will you do?_________________________________
_____________________________________________________________________________

22) Have you made arrangements for your bird(s) in the event of your illness or death?
No__ Yes__

I have completed the above application and have read the provided information. I understand that a staff member will review my application and that the shelter has a right to refuse adoption to any applicant.

Signature___________________________________________________________________

Date__________

**Note: Answering yes or no to any of the above questions will not necessarily result in your qualification/disqualification as an adopter.

*The Bird Adoption Application was prepared by Monica Engebretson, Grassroots Coordinator, Animal Protection Institute and Eileen McCarthy, Co-Founder/Executive Director, Midwest Avian Adoption & Rescue Services, Inc. - please copy, distribute and utilize this document in its entirety for the benefit of all companion birds in your care.

Courtesy of
Monica Engebretson, Animal Protection Institute
and
Eileen McCarthy, Midwest Avian Adoption & Rescue Services, Inc.

Next in For Shelters: Sample Shelter Forms:
Bird Adoption Application Evaluation Guide