Adoption Qualification Form

Adoption Qualification Form 18+

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 NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth

MonthDayYear
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?
Upload Your ID

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Would YOU like to donate for food and medical costs?
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
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Application Fee
This is a donation to be used to buying food for the parrots. This fee will also go towards the adoption of your bird or it can stay for the food. It is totally up to you.

$25.00 Quantity

Total

$0.00
Payment Methods

Fastlane Checkout

Choose from one of the PayPal options to make your payment.

Contact Info

Payment Info
Should be Empty:

Adoption Qualification Form 18+