Adoption Qualification Form
We are located in Arizona. In person visits are mandatory. We never ship any of our birds. If You live out of state, You can either make it a road trip or fly through Delta Airlines.
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of Birth
*
-
Month
-
Day
Year
Date
Which Parrot do YOU like?
*
Where would they live?
*
Describe the Setting
Are there any other birds in YOUR home?
*
What kind of cage do YOU have or do YOU Require one?
*
Tell us about Yourself and Your Experience
*
What do YOU do for work and how much time do YOU spend at home?
*
Waiver
I understand that although uncommon, parrots can nip, bite and scratch. I hear my relinquish Valleywide Parrot Rescue from any liability from all possible damages and losses to me and my Party.
Signature
*
Optional Donation
prev
next
( X )
USD
Your Continued Support Makes You a Partner in Saving Parrots from Cold Cages to Warm, Caring Homes.
Payment Methods
Debit or Credit Card
Please click one of the PayPal options to complete payment and
submit
the form.
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