Parrot Bio Relinquishment Form

Date:

Are you the owner of this parrot?

Yes
No
Custodian
Other

Other:

Are you the custodian of this parrot?

Other:

Your Name:

First

Last

Address:

Address Line 1

Address Line 2

City

State

Zip Code

Are you using well water at this location?

Yes
No
Bottled water
Other

Other:

Phone Number:

Secondary Contact Phone Number:

Email:

Parrot's Name

Type of Parrot

Sex of Parrot

Male
Female
Unknown

Sex of the parrot determined by:

Surgical
DNA
Unknown
Other

Other:

Does this parrot prefer men, women, or children ?

Please provide a brief description of the primary handler(s) of this bird (age, hair color, etc.)

How long have you had your parrot?

How old was your parrot when you took him or her in?

Age of parrot now:

Is she/he hand tame?

Yes
No
Unknown
Other

Other:

Does this parrot prefer the right hand or left hand for stepping up?

Other:

Does this parrot prefer to step forward or step backward?

Other:

Does your parrot have a microchip?

Yes
No
Unknown
Other

Other:

Does your parrot have a leg band number?

Yes
No
Other

Other:

What is the ID number?

Was he or she used for breeding?

Yes
No
Unknown
Other

Other:

Does he or she become nippy?

If Yes- Who or What provokes them to bite or nip? (Details are important)

How often do you take your parrot to the vet?

Other:

When was your parrot’s last veterinarian visit?

What was the reason for this visit?

Avian Vet’s Name:

First

Last

Clinic Name:

Clinic Address:

Address Line 1

Address Line 2

City

State

Zip Code

Clinic Phone Number:

Clinic Email:

Describe your parrot's overall current condition:

Has your parrot ever sustained any injuries?

Yes
No
Unknown
Other

Other:

Please describe any injuries:

Has your bird ever been treated for any illness or diseases?

Yes
No
Unknown
Other

Other:

Please explain the illness or disease and how it was treated:

Has your bird ever been given any medications?

Yes
No
Unknown
Other

Other:

Please list any medications and reasons for medications:

Has your bird ever been on herbal or other alternative therapies?

Yes
No
Unknown
Other

Please describe:

Does your bird have any medical/physical condition that requires reoccurring treatment and/or a specialized perch, cage, or play area?

Yes
No
Unknown

Please describe:

Has this parrot had any behavioral issues currently or in the past?

What time of day does this parrot cry out or scream, and do you know what provokes him or her to do so?

How do you discipline your parrot?

Other:

Does the parrot have any special, obvious identifying marks?

Yes
No
Unknown
Other

Please list the identifying marks:

Does this bird’s beak require regular trimming?

Yes
No
Unknown
Other

Has he or she been in a home with other animals?

Other:

Please give us a full description of other animals that this parrot has been around and their reactions and interactions:

Does this parrot have strong dislikes?

Other:

Does this parrot mimic, talk, or know any words?

Other:

If he or she swears, mimics any sounds, or speaks any words/sentences; please enter them below

Does he or she sing songs?

What songs does he or she sing or whistle?

Does the parrot like music?

Yes
No
Unknown
Other

Please list the different types of music that the parrot is accustomed to:& Speial Conditioning

Does the parrot like television?

Yes
No
Unknown

What types of programs do you or te parrot views

Other:

What kind of toys does he or she like?

whattype of other Toys

Has the Parrot lived in a household with smokers (cigarettes, cigar, other)?

Do you burn candles in your household?

Yes
No
Sometimes
Other

Other:

Has the parrot been outside the home on overnight trips?

Does the parrot get carsick?

Yes
No
Unknown
Other

Other:

How does this parrot react to outsiders?

Does this parrot like baths?

How do you bathe your parrot?

How often does he or she take a shower?

*Important * Describe your parrot’s current daily diet, including brands of seed mix or pellets:

Does your parrot like table/human food? If yes, what foods?

What are the parrot's favorite fruits/veggies?

Served warm or cold?

Does the parrot have any strong food favorites or dislikes?

Nuts/ Unshelled/shelled:

Special favorite treats:

Favorite cooked foods:

Favorite fruits and vegetables:

Favorite table foods:

Favorite foods:

Will the parrot stay on a perch or cage top if left alone?

Yes
No
Unknown

Do you need a padlock or link for the parrot's cage?

Yes
No
Unknown

Will the parrot come out of his/her cage on your hand?

Does the parrot know the "Step up" command?

If not, how does the parrot get in and out of his/her cage?

What time does he or she wake up?

6am to 8am
8am to 10 am
10 to noon
Unknown

What time does he or she go to bed?

Daily morning routine:

Daily afternoon routine

Daily evening routine

Do you cover the cage at night?

Yes
No
Unknown

Other:

Describe the type of blanket you use:

What type of laundry detergent do you use (if scented, name brand)?

Can you donate the parrot's security blanket?

Yes
No
Unknown

Type and number of perches in cage:

Type and number of toys inside or outside of cage:

In what room was the cage located?

In the cage area, how was traffic flow?

In the cage area, are there any animals free roaming?

Yes
No
Unknown

What types of roaming animals

How many hours a day is the bird usually left alone?

2 to 4 hours
6 to 8 hours daily
10 to 12 hours daily
Unknown

How many hours a day is the bird usually out of his/her cage?

Is the parrot allowed to freely roam when out of his/her cage?

Yes
No
Unknown

Is he or she supervised when out of his/her cage?

Yes
No
Unknown

Has the parrot ever bonded with another bird or animal

Yes
No
Unknown
Other

Other:

What breed and sex of other bird whe/ she was bonded too?

Is the parrot stick trained?

Yes
No
Unknown

Other:

Is the parrot afraid of a training stick?

Yes
No
Unknown
Other

Other:

Does the parrot pluck or overpreen?

Yes
No
Unknown
Parcialy feather plucked

Do you know of any triggers for this type of behavior?

What steps have you taken to modify this behavior?

Is this parrot used to being toweled?

Yes
No
Unknown

Other:

Has this bird been allowed on shoulders?

Yes
No
Unknown

Do you know who this parrot's prior owners were?

Yes
No
Unknown

Do you know how long the previous owners had this parrot?

Do you know why they needed to rehome this bird to you?

Why do you need to place this bird up for adoption?

* Is there anything Special else you would like a new owner to know about this parrot?

Items with bird (toys, perches, accessories):

Cage size, description, and dimensions:

What is the exact location of each bowl? In other words, where is the water bowl, seed or pellet bowl, treat bowl, etc. located?

If possible, please upload a photo of cage(s)

Click or drag a file to this area to upload.

If possible, please upload a photo of your parrot with cage(s)

Click or drag a file to this area to upload.

If possible, please upload any additional photos of your parrot(s)

Click or drag a file to this area to upload.

If possible, please upload any additional photos of your parrot(s)

Click or drag a file to this area to upload.

I/ We understand that the placement of our parrot is a serious matter.

Confirm.

I/ we understand that there is a suggested donation contribution requested for relinquishment into this program. The donation contributions are determined by several factors depending upon the needs of various sizes of parrot. This will ensure the quality care that a relinquished parrot requires. Some parrots take years to find their new vetted forever homes. Please review and check the appropriate box for the size of parrot below. * We will call you within 24 hours of receipt of your form. If you don't hear back from us within 24 hours of submission, please call us at 916-956-2153.

Confirm.

I/we understand that there is an suggested relinquishment donation for all placements. Please check the appropriate box for your size of parrot:

Large Parrots (Macaw and Large Cockatoos) (Macaws 650.00) (Large Cockatoos 600.00) *Total reservation donation per parrot
Medium Parrots ( Eclectus and Medium Cockatoos 550.00, African Greys 500.00) *Total reservation donation per parrot
Medium/ Small Parrots (Amazons 500.00, Pionus or Indian Ringneck 400.00) *Total reservation donation per parrot
All Other Small Parrots (Conures or Quakers 350.00, Cockatiels 300.00, Parakeets 150.00)
Flocks of 3 to 5 Small Birds (Finches - Parakeets 75.00 per bird +/- depending on size of flock, special needs, and conditions)

Your Full Name

First

Middle

Last

Would you like to be in contact with the new adopter?

Any additional important information that you would like the new adopter to know?

Second Chance Bird RescueWest Coast Division

Second Chance Bird Rescue
West Coast Division