RELEASE

Release / Surrender Form
Parrot Outreach Society Email: admin@parrotoutreachsociety.org 1205 Elizabeth Street, Suite I & J www.parrotoutreachsociety.org Punta Gorda, FL 33950 941-347-8876
Surrendering my birdReturning My Bird to Parrot Outreach Society
Date of Relinquishment*

MonthDayYear
Date
Owner's Name*

First NameLast Name
Email*
example@example.com
Cell Number*
Please enter a valid phone number.
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Spouse's Number

First NameLast Name
I unconditionally release the bird described below to Parrot Outreach Society and certify that the information provided herein is true to the best of my knowledge.
Bird's Name:*
Species:*
Color:
Age:
MaleFemaleUnknown
YESNO
YesNoNot Sure
YESNO
STEPS UPPERCH TRAINEDTOWEL TRAINEDBIRD IS UNHANDLED
IF BIRD IS UNHANDLED DO YOU KNOW THE LAST TIME IT WAS OUT OF IT'S CAGE?
YESNO
Who was the primary caregiver for your bird?:
NOMALE'SFEMALE'S
Diet: What is your bird's typical daily diet?:
Bathing: What is your bird's favorite way to take a bath?
Has your bird ever been to the vet?*
If so, when was the last time your bird saw a vet?
Current Veterinarian:

First NameLast Name
Phone Number
Please enter a valid phone number.
YESNO
YESNONOT SURECAN FLY BUT NOT WELL
Previous surgeries, injuries or illnesses:
Who grooms your bird? (NAILS, WINGS, BEAK)
When was the last time?
Is your bird flighted or are his or her wings clipped?
When was the last time this bird was out of its cage?
Cage size. Include width x depth x height:
Time bird spends in cage and when:
Describe the exercise and activity level of your bird:
YESNO
If not, explain how you transport your bird within your home
Amount of time bird spends out of cage, when and where:
YESNO
YESNO
YESNO
If yes, please explain_
YESNO
If yes, please explain_
Please list other members of your household that interact with the bird and describe their relationship
Does the bird have a favorite person?
Is your bird fearful of anything or of certain events in your household?
List other animals in your household:
not enough timebird's best interesttoo messy, loud, destructivebehavior; biting, noise, aggressionbird's failure to meet expectationsnew spouse/conflict in relationshipdeath of ownerowner illnessbird's medical needsplucking/not attractivefinancial hardshipmoving/change in living situationnew baby/conflict with children
Additional reasons
Date acquired:

MonthDayYear
Date
Where did you acquire this bird?
Was it a planned purchase? Explain,
YESNON/A
At what age was your bird weaned?
YESNON/A
Are there specific behavioral problems with your bird that are the reason for this bird's placement with us?
When did the problem(s) start?
Details:
Please list any changes that you or others in your household made to lessen the bird's unwanted behavior and increase acceptable behavior?
Thank you for taking the time to provide us with this important information to make the transition as easy as possible for your bird. While we work hard to find your beloved bird a great new home, he/she will be provided with an abundance of healthy and fresh foods, lots of toys and enrichment, vet care, interaction, and lots of love. Please consider a monetary donation of any amount towards the upkeep of your bird while in our care. If you are relinquishing for financial hardship reasons, please disregard this.
DONATION AMOUNT AT TIME OF DROP OFF?
I certify that I am the owner of the animal described herein. I understand that there are no written or verbal guarantees given or implied regarding the placement of this animal other than the POS Rescue's best effort to find a good home for the pet. I promise to provide any or all pertinent medical information. I DO/DO NOT (circle one) authorize new adoptive parents to contact me concerning the above described animal. I realize by signing this document that I am relinquishing all legal rights to this bird and will have no further say in its care or adoption placement.
OWNERS SIGNATURE*

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PICTURE OF YOU LICENSE*

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Release / Surrender Form

Parrot Outreach Society Email: admin@parrotoutreachsociety.org 1205 Elizabeth Street, Suite I & J www.parrotoutreachsociety.org Punta Gorda, FL 33950 941-347-8876