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916-956-2153
bordend@sbcglobal.net
19084 Dayton Rd
Bend, OR 97703
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Parrot Bio Relinquishment Form
admin
2023-12-05T17:22:54+00:00
Parrot Bio Relinquishment Form
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Date:
*
Are you the owner of this parrot?
*
Yes
No
Custodian
Other
Other:
Are you the custodian of this parrot?
*
Yes
No
Decesed Family Member
Deceased Spouse
Spouse
Other
Other:
Your Name:
*
First
Last
Address:
*
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
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 ?
*
Men
Women
Likes boys
Likes girls
Dislikes children
Unknown
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?
*
Right hand
Left hand
Both hands
With a towel or other object
Steps up onto stick
Not tame at all
Unknown
Other
Other:
Does this parrot prefer to step forward or step backward?
*
Forward step
Backward step
Both
Unknown
Other
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?
*
Yes
No
Only when provoked
When scared
Never bites
Unknown
Other
If Yes- Who or What provokes them to bite or nip? (Details are important)
*
How often do you take your parrot to the vet?
*
Annual checkup
When needed
For grooming
Unknown
Never been to any veterinarian
Other
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
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
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?
*
Biting
Nipping
Crying out
Screaming
Grinding on hand or toy
None
Other
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?
Spray bottle
Put in a second room
Put in a dark room
Cover cage
Yell at them
Unknown
Other
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 parrots
Dogs
Cats
Unknown
Other
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?
Vacuum cleaner
Blenders
None
Unknown
Other
Other:
Does this parrot mimic, talk, or know any words?
*
Yes
No
Mimicks sounds
Just cries out loud
Unknown
Swears
Other
Other:
If he or she swears, mimics any sounds, or speaks any words/sentences; please enter them below
Does he or she sing songs?
*
Yes
No
Unknown
Whistles
Other
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
*
Nature channel
Cartoons
News
Game shows
Sitcoms
Radio
Other
Other:
What kind of toys does he or she like?
Soft wood
Hard wood
Plastic
Cloth
Metal bells or toys
Unknown
Other
whattype of other Toys
Has the Parrot lived in a household with smokers (cigarettes, cigar, other)?
Yes
No
Never
We smoke in the back room
Unknown
Vape
Other
Do you burn candles in your household?
Yes
No
Sometimes
Other
Other:
*
Has the parrot been outside the home on overnight trips?
Yes
No
Unknown
Yes, overnight trips
Just short car rides
Outside cage
Camping
The parrot travels a lot with companion
Other
Does the parrot get carsick?
*
Yes
No
Unknown
Other
Other:
How does this parrot react to outsiders?
*
Suspicious and shy at first
Loves everybody
Will step up onto anyone
Fine, very sociable
May take a while to earn trust before you can handle
Stands off and may nip or bite
Unknown
Does this parrot like baths?
*
Hates all water
Yes
No
In the shower with me
Spray bottle
In the sink
Unknown
How do you bathe your parrot?
*
Parrot takes a bath in his cage in its water bowl
My parrot never showers
Mist or spray bottle
In shower on perch
In shower on arm
Kitchen sink
On perch in or while on cage
In cage in water bowl
Outside on perch with hose or spray bottle
Unknown
How often does he or she take a shower?
*
Daily
Once per week
Twice per week
Once per month
Rarely bathes
In their water dish
Unknown
*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?
*
Yes
No
With a training stick
Unknown
Other
Does the parrot know the "Step up" command?
*
Yes
No
With a training stick
Gloves
Unknown
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?
*
6pm to 8pm
8pm to 10pm
10pm to midnight
After midnight
Nightowl
Unknown
Other
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?
Low, 1 or 2 humans
Medium, 3 to 5 humans
High, 5 or more humans
Other animals
Unknown
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?
*
Yes
No
Undecided
Yes via email only
Yes both email and phone
Any additional important information that you would like the new adopter to know?
Submit
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