Adopters Name *
Adopters Name
Age *
Partners Name
Partners Name
Partners Age
Do you have any children living (full or part time) in your home? *
Phone No.
Phone No.
Address *
Address
Who will be the bird's primary caregiver? *
What type is your residence? *
Do you rent or own your home? *
If rent, does your landlord allow pets?
Does anyone in your household have a health condition(s) that could restrict his/her ability to handle/care for a bird?
Does anyone in your home have allergies? *
Do you currently have other birds living in your home?
Does anyone in your home smoke?
Have you previously owned birds you no longer own?
Do you currently have any other pets living in your home?
Do you currently have an avian veterinarian?
Avian Vet Name
Avian Vet Name
Clinic Address
Clinic Address
Clinic Phone
Clinic Phone
What type of bird are you interested in (check all that apply)? *
AGREEMENT
I understand this bird must remain in my home. If my circumstances change, I understand I must contact A Helping Wing. I will forward any changes to my address(es) and/or phone number(s) to A Helping Wing. I also agree to a home visit prior to approval, and I understand that A Helping Wing representative may make periodic visits to my home. I also understand that A Helping Wing may contact my references prior to approval of this application. *