N. W. Bird Rescue & Adoption Orphanage Inc.

13215 S.E. Mill Plain Blvd.
Suite C-8 P.M.B. # 101 VANCOUVER, WA98684

Business Office: (360) BIR-DMAN = 247-3626 Fax: (360) 260-2743 (Bird)

E- Mail;.

OrE-mail;

N.W. Bird RescueAdoption Application

HOME VISITS MAY BE REQUIRED IN ADVANCE ~

1.)Applicants name:______

2.)Applicants name:______

Address: ______

City: ______State______Zip Code ______

Mailing address: ______

Primary contact Phone # ( ) ______- ______

Best time to call ______Ask for: ______

Secondary Phone # ( ) ______- ______

Best time to call ______Ask for: ______

E-mail address ______@______

Which of the following the best describes your residence? House___ Mobile Home ___Duplex ___ Condominium ____ Apartment___

Length at current residence: Years___ Months___

Do you work more than 50 hours a week? Yes___ No ___

Do you have children? If so what ages? ______. ______.

Do you currently have any birds? If so what Type: ______

______

Do you have any other types of pets? (If so what type, species age) ______

What type of bird are you applying for?______
Do you currently have an avian veterinarian? How much time can you allow your new bird to play out of the cage? ______

I/ We understand adoption of a bird is a life long commitment:

I/We understand that we cannot: Breed/Trade or sell this adopted birr and N.W. Bird Rescue holds first right of rescission. (Return the Bird Back to N.W. Bird Rescue).

If I/ we cannot provide a God Parent for our newly adopted bird in case’s of emergency. *We promise to return this bird back to N.W. Bird Rescue

Have you selected a God Parent? If so please include their name in case of an emergency:

Name: ______

Address: ______

City: ______State: ______Zip Code: ______

Contact Phone number ( ) _____ - ______

*If we can not provide a God Parent we promise to relinquish this bird back to N.W. Bird Rescue.

N.W. Bird RescueAdoption Application

HOME VISITS MAY BE REQUIRED IN ADVANCE ~

In Addition: I/ we promise to provide a safe haven for our newly adopted bird. We promise a loving nourishing home, with a proper diet of fruits and vegetables. We also promise to provide this bird with medical care for this bird if needed. We also promise that we will never breed, sell or trade this newly adopted parrot.

If for any reason we can no longer care for this parrot, we promise to return it back to N.W. Bird Rescue.

  1. I/We promise to love honor and cherish our newly adopted bird for life. If I/We cannot, I/We promise to return our adopted orphaned Bird named: ______, aka; ______an apparent ______Year old(Female / Male) ______of ______species Back to N.W. Bird Rescue.
  1. I/We promise to love honor and cherish our newly adopted bird for life. If I/We cannot, I/We promise to return our adopted orphaned Bird named: ______, aka; ______an apparent ______Year old(Female / Male) ______of ______species Back to N.W. Bird Rescue.

I/We promise NOT to sell/trade or Breed the above-mentioned Bird/Birds, without the express written permission of N.W. Bird Rescue Inc.

I/We also understand that N.W. Bird Rescue may conduct up to three surprise home visits within the next 2 years of adoption. *Hours of surprise visits are to be within the hours of AM 9 PM Monday thru Sunday 7 days a week including minor holidays.

Surprise Visit Disclaimer

If any member/volunteer or Officer of N.W. Bird Rescue deems this Parrot or parrots are neglected, in danger or in poor condition.

I/We promise to immediately surrender this parrot and all adopted parrot belongings, including cage and all toys, are to be given back to N.W. Bird Rescue immediately, to the representative of the Orphanage.

I/We also understand that any and all donations (Fiduciary or other wise) that have been contributed to N.W. Bird Rescue will be forfeited.

* We currently do not have an approved Godparent for N.W. Bird Rescue. So we promise to will these two birds back to N.W. Bird Rescue incase of any emergency.

By signing this agreement we agree to the terms above:

Adoptive Parent #1: ______Date: ______

Adoptive Parent #2: ______Date: ______

Printed name of representative: ______

Representatives Signature: ______

Title: ______

Location: ______

Time: ______Date: ______

Notes:

Office Use Only

___ Approved ApplicationDate ______Denied Application Date ______

Reason for approval/denial: ______

Breed of parrot applicant is approved for: ______

___ Home visit occurred Date: ______

Notes: ______

___ Information to be given to applicant:

___ Diet___ Bathing___ Housing ___ Grooming

___ Quarantine___ Introduction period

___ Physical disabilities/limitations of bird

___ Medicating

Adoption Date: ______Donation given? ______

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