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
Street Address
City
State
ZIP Code
I agree to present a valid government-issued photo ID at the time of bird handoff for verification of identity.
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.
Photo of the bird (optional but strongly encouraged)
Reason for Surrender
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
Current or most recent veterinarian — Name & Clinic
Veterinarian phone number
Please enter a valid phone number.Format: (000) 000-0000.
Species & Coloration
Approximate Age (Best Guess)
Leg Band / Microchip Number (if applicable)
Has the bird ever been ill or disease tested?
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.
I certify that I am the lawful owner and have full authority to surrender ownership of this bird.
Is the bird subject to any legal dispute (lien, seizure, custody, divorce, estate claim, or legal hold)?
If yes, please explain
Has the bird bitten or caused serious injury to any person or animal?
If yes, please explain
To the best of my knowledge, I have disclosed all known medical, behavioral, and environmental issues affecting the bird.
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 )
USDDescription
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
Payment Methods

Fastlane Checkout

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

Contact Info

Payment Info

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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)

Optional Donation Amount

Acknowledgment & Signature

Accepted by (Rescue Representative)

Payment Methods