Bird Adoption Application | Melt My Heart Rescue

Bird Adoption Application

Contact Information

First Name

Last Name

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Phone/Mobile

Household Information

Do you own or rent your home?

Own

Rent

If renting, any pet restrictions?

If renting, landlord contact information

Do you live in a

House

Condo/Apartment

Parents Home

How many people in your household?

Ages of children under 18, if any?

Do children regularly visit your home?

Are you over 18?

Occupation?

Are there any smokers?

Experience with parrots?

Are you willing to go through a parrot safety class?

Yes

Current Pets

TYPE AND BREED OF PET	AGE	GENDER	ALTERED? (If not, why?)	Kept inside/outside/both	How long lived with you?

Previous Pets

TYPE AND BREED OF PET	How long lived with you	Reason no longer living with you?

My Home Environment

Activity level in my household is

On average, my home will be without people ____ hours a day ____ days a week?

When home alone, my bird will be

I can spend ____ hours a day entertaining my bird

If my bird outlives me my plan is:

Why do you want a parrot?

My enrichment plan for my bird:

My training plan for my bird:

It’s most important to me that my bird

What would cause you to give up a bird

What is your plan if the bird needed unexpected vet care

References

Current Veterinarian Or planned local avian vet

Phone/Mobile

*Please let the vet know to authorize us to call and discuss with your vet and ensure your pets are up to date*

1st Non-Relative Reference

First Name

Last Name

Phone/Mobile

Relation:

Length of time known:

2nd Non-Relative Reference

First Name

Last Name

Phone/Mobile

Relation

Length of time known

*3rd reference may be humane society*

Submission

I am applying for (pet name)

I have read and understand the above application and have filled out this form honestly to the best of my ability and certify the above true and am in agreement with the above information and consent.

I consent to having this website store my submitted information so they can respond to my inquiry