Surrender Form

Is this a found bird? *YesNo

Where was the bird found? Please use cross streets *

Finder Information

Family

Finder Name

Owner Name *

Owner Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Phone *0 / 10

Email Address *

How many birds are being surrendered? *

Veterinarian's name

Vet's Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Vet's Phone

Vet's Email Address

Vet's Website

Have any other animals or persons in the household had any illness in the last 30 days?

Have you or any members of your family been out of the country within the past year? *

If so, where?

Does anyone in the household use tabacco products? *

Do you use any aerosolized products? *

Do you use Teflon pans? *

Do you use a self cleaning oven? *

Last self-clean cycle? *

Any changes in the bird’s environment within the last 30 days? *

Bird Profile

Bird's name *

Species *

Sex (if known) *

Hatch date or approximate age *

Band or microchip number *

Last time the bird went to the vet *

Have you noticed any change in your bird’s behavior? If yes, please give details: *

Has your bird received any treatment in the last 30 days? If yes, please give details: *

Is your bird vaccinated? *

Does your bird get wing trims? *YesNo

If so, who does them? *

Pellets, Seed, or both? *PelletsSeedBoth

Type of pellet/seed and how much daily? *

What are her/his favorite foods?

Do you give peanuts? *YesNo

Will the bird step up on request? *

Do you let him/her out of the cage? *

How often? *

How long? *

Is the bird stick or towel trained? *

Do you get him/her in and out of the cage by stick or hand or let them do it themselves? *

Is he/she noisy?

Is he/she more noisy at any particular point of the day?

Does any particular thing trigger the noise?

How do you stop him/her from being noisy? *

Does he/she bite? *

What seems to trigger the biting? *

Does he/she give any warning signs before he/she bites? *

Problems with hands?

Is he/she afraid of anything (noises, colors, vacuum, animals, etc)?

Does he/she have a favorite type of toy?

List any behavioral quirks (good, bad) *

Does the bird get baths?

And where (sink, tub, etc.)

And if so, how (shower, mist, bath)?

Does he/she have a bedtime?

Do you cover the cage at night?YesNo

Do you have other birds or pets? please give details *

When was the last bird added to your collection? *

Has the bird ever lived in the same cage as another bird? *YesNo

How long did they live together? *

What kind of bird was it?

Was the bird used for breeding? *Even if by accident

Are you the birds’ first owner? *YesNo

If not, please give as much background as you can *

Where was the bird obtained? *

How long have you had this bird? *

Does this bird have a reproductive history? *

When did your bird last molt?

How often has your bird been molting?

Prefers which sex?

Does the bird talk?

Please give any additional information you wish to share such as past or present injuries, surgeries, markings *

If the owner is recently deceased, please provide executorship documentation and/or copy of Trust that allows you to turn the bird over to PRH.

No file chosen

Donated items and/or amount

Are you interested in filling out an adoption application if the owner can't be located?YesNo

Finder Information

Family

Bird Profile

Papayago Rescue House

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