Parrot Guardian Application Form

Are you a veteran?

Other:

Your name:

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Email

Phone Number

Type of phone:

Cell Phone
Landline
Message Phone
Other

Other:

What is the best time to call you?

Name of your emergency contact person:

First

Last

Phone number of your emergency contact:

Relationship to your emergency contact:

Friend
Spouse
Immediate Family member
Other

Other:

Is there a Specific Parrot that you are willing to be the care provider for? *

Other:

If you are to be the designated Guardian for a certain parrot, please select the first option and enter their information below.

I am a guardian for a specific parrot
I am not a guardian for a specific parrot

Name of Current Parrot Custodian:

First

Last

Their Phone Number:

Name of parrot and or nickname of parrot:

Age of parrot (if known)

Sex of parrot (if known)

Size of parrot:

Other:

Breed of Parrot:

Other:

Additional information about parrot breed, age, sex, etc.

If A flock of 2 or more, please describe all in this flock. Exactly what type of parrot/ Age/ and sex if known:

If you're an assigned - Guardian/ Godparent or Designated Survivor for a currently adopted Parrot. Please fill in the adopters information Below. ****Please skip if your an assigned designated survivor***

I am an assigned guardian/godparent
I am not an assigned guardian/godparent or designated survivor
I am a designated survivor

Current caretakers name:

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Have you handled this parrot/parrots?

Other:

What size parrot do you have experience with?

Other:

Do you currently have any parrots?

Yes
No
Poultry Birds
Other

What size?

Small {Finch-Lovebird-Parakeet-Cockatiel}
Medium {Small -Cockatoo- African Grey- Amazon}
Large {Macaw-Large Cockatoo}
None, just past experience
Other

Other:

How many large parrots do you currently have?

Other:

Medium parrots?

Other:

Small parrots?

Other:

How much parrot handling experience do you have:

Other:

What size household do you have?

Other:

Are you the head of the household?

Yes
No
Shared head of household
Other

Other:

Do you:

Other:

How long have you lived at your current address?

Other:

Do you have your own vehicle? If so, what type?

Other:

Are you willing & able to pick up any parrot during an emergency?

Yes
No
Other

Other:

Do you have your own backup Parrot Guardian?

Yes
No
I have someone in mind
Other

Other:

If you have a back up Parrot Guardian please give us their information:

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Email

Do you have any questions for us, or a note for us?

Second Chance Bird RescueWest Coast Division

Second Chance Bird Rescue
West Coast Division