Waterfowl Adoption Application

Full Name*

First NameLast Name

E-mail*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number - Home

Area CodePhone Number

Phone Number - Cellular*

Area CodePhone Number

Phone Number - Work

Area CodePhone Number

Do you live in a:*

Do you:*

OwnRentLive with ParentsOther

Household Setting*

RuralCity

Describe the Activity Level in your Home*

Busy/NoisyModerate Comings/GoingsQuiet with Occasional Guests

Please List all People Living in the Household (Include Name, Relationship, Gender and Age)*

Does Anyone in your Household have Allergies to Animals?*

YesNo

Are all members of your family agreeable to adopting a duck/goose?*

YesNo

Please List any Pets currently living in the household or who visit the household regularly

Have the other animals in your household had contact with waterfowl?

YesNo

Do you already have a veterinarian?

YesNo

Veterinarian Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number

Area CodePhone Number

Do you have other waterfowl?

YesNo

What sex are you looking for?

MaleFemaleNo Preference

If you have other waterfowl, what size are they?*

SmallMediumLarge

Please describe your experience with waterfowl*

Please describe your housing for waterfowl.

Do you have any other birds (chickens, turkeys, geese, ducks, parrots, guinea or pea fowl)?

Have you ever had any predator issues with your current pets?

YesNo

If Yes please explain

Do you expect to free range during the day?

YesNo

Do you have a fenced yard?

YesNoPartial

Are you willing to allow a member of our team to visit your home and make suggestions or recommendations as to housing & predator proofing??

YesNo

If fenced, please give details on height, material, # of gates, are gates locked or lockable?

Are you interested in adopting a special needs animal?

YesNo

If Yes please explain

Please tell us why you want to adopt a duck or goose to add to your family.*

Click to edit

MonthDayYearHourMinutesAM/PM Option

By sending this electronically, I acknowledge that I have completely read this questionnaire and comprehend it fully.

I understand that applying does not ensure approval and that untruthful answers or failure to comply with the requirements of this application can result in the forfeiture of any Soft Landings animal adopted by me.

I certify that the above information is correct, and I understand that the information will be verified.

I understand that by submitting this form electronically, I agree to release and covenant to hold harmless Soft Landings of Tennessee and it's members from any claims, damages, costs, or actions incurred because of the care or actions of the adopted waterfowl.

I accept full responsibility for the actions of my pet at all times, and release Soft Landings from any liabilities or damages that may be incurred because of adopting such waterfowl.

I agree to have Soft Landings of Tennessee complete reference call checks and conduct a home visit inspection to be able to approve my application.

I agree that if for any reason I'm unable to provide a permanent home for the adopted waterfowl that I will return the adopted waterfowl to Soft Landings and try to give Soft Landings a 2 week period to try and find another suitable home for the waterfowl.

I agree that any adopted waterfowl will not be used in any breeding program or for hatching eggs.

I AGREE THAT WE ARE ADOPTING A PET AND NOT FOOD. No adopted waterfowl will be eaten. Unless specifically provided in writing by Soft Landings, no waterfowl has been tested for salmonella and any eggs are eaten at our own risk.

Co-Applicant name (if applicable)

Your name*

WATERFOWL ADOPTION APPLICATION