Cindy's Bird Haven™

From Beaks and Snouts,
To Tails and Feathers,
Cindy's Bird Haven's the Best
No One Else Could Do Better!

Companion Bird Rescue Adoption/Foster Application

 

Name:________________________________________________

 

Address:_____________________________________________

 

City/State/Zip:________________________________________

 

Email:________________________________________________

 

Home phone:________________________________________

 

Cell phone:__________________________________________

 

Which species would you like to adopt, and why? If unsure, check multiple species and explain each. ( )African Grey ( ) Amazon ( ) Budgie/Parakeet ( ) Caique ( ) Canary 

( )Cockatiel ( ) Cockatoo ( ) Conure ( ) Dove ( ) Eclectus 

( )Finch ( ) Lorikeet ( ) Lovebird ( ) Macaw ( ) Parrotlet 

( )Pionus ( ) Pigeon ( ) Poicephalus ( ) Ringneck ( ) Rosella 

 

Enter explanation here : ____________________________________________________________________

____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________

____________________________________________________________________ ____________________________________________________________________

 

Spouse/Significant other/Roommate Name: __________________________________________________________

 

If the relationship were to change, who do you anticipate keeping the bird? 

____________________________________________________________________

____________________________________________________________________

 

Do all adults in the household know that you are applying to adopt/foster a bird? ( )Yes( ) No

 

Who in the family initiated a desire to adopt/foster a pet bird? 

____________________________________________________________________

____________________________________________________________________

Who will be primarily responsible for the birds' care? 

____________________________________________________________________

____________________________________________________________________

Childrens' ages, if any: ____________________________________________________________________

____________________________________________________________________

 

How many hours per day will the bird be left alone? 

____________________________________________________________________

____________________________________________________________________

 

Do you travel a great deal? ( )Yes( ) No

 

When you are away, who will care for the bird? 

____________________________________________________________________

____________________________________________________________________

 

Type of dwelling: ( )House ( )Apartment ( )Condo ( )Other            Do you: ( )Rent( ) Own

 

If you rent, do you have your landlords consent to have a bird? ( )Yes ( )No

 

Please provide written proof if applying to adopt or foster a bird larger than a cockatiel.)

 

Landlords' name and phone number: 

____________________________________________________________________

____________________________________________________________________   

 

Do you, or does anyone in your household smoke? ( )Yes ( )No

 

If yes, would you be able to provide a smoke-free environment for a foster or adopted bird? ( )Yes ( )No

 

Would you allow an inspection of, and post-placement follow-up visit to your premises by an CBH volunteer? ( )Yes ( )No

 

Do you currently have any birds? ( )Yes ( )No

 

If yes, how many and what species?

 

____________________________________________________________________

____________________________________________________________________ ____________________________________________________________________

____________________________________________________________________

 

How long have you had each bird?

____________________________________________________________________

____________________________________________________________________

 

Have you taken care of birds in the past that you no longer have? If so, what species?

____________________________________________________________________

____________________________________________________________________ ____________________________________________________________________

____________________________________________________________________

What other animals do you have? (be specific)

____________________________________________________________________

____________________________________________________________________ ____________________________________________________________________

____________________________________________________________________

Do you have a separate quarantine area for new birds (a separate room with a door shut)? ( )Yes ( )No

 

If you have birds, are your birds wings clipped? ( )Yes ( )No

 

If so, who clips them? ________________________________________________________________________

 

How do you currently discipline your birds? Be specific. 

________________________________________________________________________

What do you feed your birds? Be specific. ________________________________________________________________________

Do you/would you let your birds out of the cage daily? ( )Yes ( )No

 

If yes, for how long and where are they out?

________________________________________________________________________

 

What would you do if you came home one day and found your bird on the bottom of the cage, obviously ill?

 ________________________________________________________________________

________________________________________________________________________

Are you aware that exotic birds may develop bad habits (Destruction of clothing, furniture, draperies, or anything within reach; biting, screaming, dislike of strangers or your mate, leaving droppings everywhere) and that these habits can be difficult to break; that they require a great deal of attention and maintenance; that they can be expensive to keep fed, healthy, housed, and entertained?

 

( )Yes, I knew that. ( ) Well, I know now!

 

If the bird does develop a bad habit, what would you do?

________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

 

ADOPTION ONLY - All questions in the following section are required

 

 

Are you interested in adopting a bird for breeding purposes? ( )Yes ( )No

 

Are you planning keeping your adopted bird(s) in an aviary situation? ( )Yes ( )No

 

If yes, indoors or outdoors: ( )Indoors ( )Outdoors

 

Are you aware that bird medicine can be very expensive should your bird get sick? ( )Yes ( )No

 

If your bird does become ill, will it be a financial burden for you? ( )Yes ( )No

 

If yes would you take him/her to the vet anyway? ( )Yes ( )No

 

Would it be a hardship for you to take your bird to an avian vet for annual check ups? ( )Yes ( )No

 

Do you know an avian veterinarian? ( )Yes ( )No

 

If yes, who?

____________________________________________________________________

____________________________________________________________________

What vet hospital does s/he work for?

____________________________________________________________________

____________________________________________________________________

In what city?

____________________________________________________________________

____________________________________________________________________

 

Would you like us to recommend an avian veterinarian? ( )Yes ( )No

 

Under what circumstances would you NOT wish to keep the bird? ( )  Moving  ()Divorce/Separation  ( )New Baby  ( )New Job ( ) Loud/Noisy  ( )Biting/Aggressive to pets or humans  ( )Allergies ( ) Doesn't get along with other pets  ( )New Relationship 

( )Bird develops serious illness  ( )Bird prefers one person more than another 

 

How important are these characteristics in a bird?

Rate on a scale of 1 to 5, with 1 being unimportant and 5 being crucial.

Color _____

Size  _____

Ease of Care  _____

Personality  _____

Uniqueness  _____

Cuddliness  _____

Talking  _____

Cost  _____

 

(FOSTER ONLY): Do you have any bird hand-feeding experience? ( )Yes ( )No

 

If yes, describe which species, the number of feedings, when you got the bird, and how long ago you last hand-fed a bird.

 

____________________________________________________________________

____________________________________________________________________

 

 NOTE:Answering yes or no to any of the above questions will not necessarily result in your disqualification as an adoptive or foster-parent. Our sole interest rests with the birds. All answers to above questions will be used to determine which home is the best for any given situation.