H.E.A.R.T. Surrender/Intake Form

H.E.A.R.T. Surrender/Intake Form
By signing this form, I state that I am the current owner of the animal(s) who is/are the subject of this animal intake/surrender form, hereinafter referred to as "the animal". To my knowledge, no other person has any right to the animal. I hereby surrender all rights of the animal to Holliday's Exotic Avian Rescue Team(H.E.A.R.T.). I understand that once I relinquish the animal, the animal will not be returned. I understand I must relinquish the animals belongings(cage, food, toys, etc) to Holliday's Exotic Avian Rescue Team(H.E.A.R.T.) to make the transition easier for the animal. I have read and understand the terms of this Animal Surrender/Intake Form.
Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number *

Area Code Phone Number
Email *
example@example.com
Animal Name: *
Animal Species: *
Animal age *
Animals Sex(if known): *
Animals Previous Vet(name of vet, name of office, address of office and phone number. If none put NA): *
Are we allowed to contact your vet for records of the animal? We like to have previous records to see what all they have been treated/tested for. *

Yes No
Reason for surrender: *
Can the bird be handled (I.E. will he/she step up) *
We require that the birds are surrendered with their belongings, such as cage/toys/perches/food. What size cage are they currently in? *
Are you able or willing to drop off the bird(s) and their belongings? *
Would you like to sponsor the bird(s) you are surrendering with a monetary donation? *

Yes No
Please understand that we cannot guarantee we will have space/room to take in your bird(s). If we cannot, we will add you to our wait list.

I understand
Time *

: Hour Minutes AM/PM Option
By signing this form, you understand and have read the terms of this surrender/intake form. To your knowledge, everything has been answered correctly. If you have given H.E.A.R.T. permission to contact your vet for any records you didn't bring, you understand H.E.A.R.T. or their vet will pull records to transfer over to their vets office. By typing your name you understand that you are signing this form virtually and is an electronic signature. *
Should be Empty: