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Adoption Application
Name
*
Phone
*
Please enter your personal phone number and not your work or school phone number
0 / 10
Email Address
*
Enter personal email not work or school email
Street Address
*
Apartment, suite, etc
City
*
State/Province
*
ZIP / Postal Code
Home
Ages of adults
*
Ages of children
*
Please give the ages of the children in the home (under 18)
Number of children living in the home
*
Number of babies in the home
Are there any tabacco users living in the home
*
Yes
No
including cigarettes, cigars, pipe tobacco, and chewing tobacco in or out of the home
Own or Rent
Own
Rent
What type of residence do you live in?
apartment, condo, townhome, modular home, etc.
How long have you lived there?
*
When do you sleep?
*
Night, Morning, Midday
Night
Morning
Midday
Your normal sleep cycle based on your job and/or activities
Describe your daily activity level
*
Example: Active lifestyle, Sports active lifestyle, Traveler, Workaholic, Homebody
Do you have any non birds at home?
*
Yes
No
What are their species/breed and associated ages
*
Border Collie and he is 10 years old
Do you currently have a companion parrot?
Yes
No
Please explain your experience with companion parrots
Employer
How do you spend your day?
*
How do you stay busy?
Employed
Own my own business
Retired
Disability/SSI
Stay at home mom/dad
Looking for work
Independently wealthy
Current Employer
How long
How many hours a week
How often do you have to travel for work?
What shift do you work?
Shift
Morning
Afternoon
Evening
Midnight
Weekends
Will you be adopting with a significant other?
Yes
No
What will you do with your bird if you have to go away on an emergency or a family vacation?
What species are you thinking of adding to your family?
*
"Parrot" isn't a species but a family. Please indicate the type of bird you think you may want to meet.
Have you done research on the species you would like to adopt?
Yes
No
Why this species?
How did you hear about PRH?
Would you like to be added to our monthly newsletter?
*
Yes
No
By checking this box, you understand that there is a non refundable adoption application fee of $27.00
*
I agree
No services, items, or birds are promised with the submittal of this adoption application.
*
I understand and agree
21 years old
*
By checking this box you are certifying that you are 21 years of age or older.
Signature
*
Checking this box is the equivalent of signing your name.
Consent
*
Yes, I agree with the
privacy policy
and
terms and conditions
.
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