Surrender Application
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What is your birds name?
*
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Reason for surrendering (select all that apply)
Overcrowded, No longer to care for
Bird is injured/ ill
Behavioral issues
Other
What is their species?
What is their age?
What is their gender?
What food diet are they currently on?
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Declaration & Agreement:I, the undersigned, confirm that I am the legal owner of the above-described bird and am voluntarily surrendering it to Wild Ones Avian Rescue, Inc. I understand that the bird will be provided care, medical treatment, and rehabilitation as needed, and that ownership will be transferred to the rescue.I acknowledge that I have provided truthful information regarding the bird’s health, history, and behavior to the best of my knowledge. (Please sign Below)
Signature
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