Parrot/Exotic Avian Surrender & Permanent Transfer of Ownership

Parrot/Exotic Avian Surrender & Permanent Transfer of Ownership

Submit this form to surrender and permanently transfer ownership of your bird to Safe Perch Exotic Avian Rescue, Inc. Please complete all required sections.
Surrendering Owner Information

Please provide your contact and identification details.
Full Legal Name*

First NameLast Name
Physical Address (Street, City, State, Zip)*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email Address*
example@example.com
Government-Issued Photo ID Number & Issuing State
Bird Information

Details about the bird being surrendered.
Bird’s Name - If Unknown type Unknown*
Species & Coloration*
Approximate Age (Best Guess)*
Leg Band / Microchip Number (if applicable)
YesNo
If yes, please explain
Veterinary History (if known)
Legal Surrender & Permanent Transfer of Ownership

Read and acknowledge the following legal statements.
Representations & Warranties

Please confirm the following statements are true.
Yes, I certifyNo
NoYes (please explain below)
If yes, please explain
NoYes (please explain below)
If yes, please explain
YesNo (please explain below)
If no, please explain
Release of Liability & Indemnification

Read and acknowledge the following release and indemnification terms.
Placement Preferences (Non-Binding)

You may share any placement wishes or preferences. These are non-binding.
Placement Wishes or Preferences (optional)
Bird History & Care Information

Help us provide the best care for your bird.
Describe the bird’s personality, likes, dislikes, favorite foods, handling preferences, injuries, special needs, or helpful tips
Length of Ownership
Prior Homes (if known)
Reason for Surrender*
Donation (Optional)

Donations help offset veterinary and care costs. Surrender fees are not required.
Optional Donation Amount

prevnext( X )
USD
Acknowledgment & Signature

By signing below, you affirm you have read and understand this agreement and sign voluntarily.
Signature of Surrendering Owner*
Printed Name*

First NameLast Name
Date*

MonthDayYear
Date
Accepted by (Rescue Representative)

For Safe Perch Exotic Avian Rescue, Inc. use only.
Date*

MonthDayYear
Date
Should be Empty:

Parrot/Exotic Avian Surrender & Permanent Transfer of Ownership

Surrendering Owner Information

Bird Information

Legal Surrender & Permanent Transfer of Ownership

Representations & Warranties

Release of Liability & Indemnification

Placement Preferences (Non-Binding)

Bird History & Care Information

Donation (Optional)

Acknowledgment & Signature

Accepted by (Rescue Representative)