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English (US)
Spanish (Latin America)
Adoption Application/Agreement
We sincerely thank you for opening your heart and home to an animal in need. At Keeks' Birdhouse, Inc., our mission is to provide compassionate care and responsible placement for birds, reptiles, and small mammals in need of second chances. We are committed to ensuring each animal is matched with a permanent, loving home where their physical and emotional well-being will be prioritized for life.
Adopter Information
Name
First Name
Last Name
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Preferred Contact Method:
PHONE CALL
TEXT
EMAIL
Animal Interested In:
BIRD
REPTILE
SMALL MAMMAL
OTHER
Type/Breed
Name (if known)
Why are you interested in adopting this animal?
Home & Environment
Do you rent or own?
RENT
OWN
If you rent, do you have landlord permission to have pets?
YES
NO
Do you currently have other pets?
YES
NO
If yes, please list type, age, and how long you’ve had them:
Do you have experience with this type of animal?
YES
NO
If yes, please explain:
Please describe the enclosure/environment you will provide:
Do you understand the dietary needs of this animal?
YES
NO
Are you aware of the expected lifespan and veterinary needs?
YES
NO
Veterinary Information
Optional but recommended.
Veterinarian Name/Clinic Name:
Phone Number
Adoption Agreement
By signing this form, I certify that:
I am at least 18 years of age.
I will provide proper food, housing, enrichment, and medical care.
I will not resell, breed, or release the animal into the wild.
I understand the rescue may deny my application for any reason.
I give permission for a follow-up visit or check-in as needed.
Printed Name
First Name
Last Name
Signature
Date
-
Month
-
Day
Year
Date
Continue
Continue
Should be Empty: