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					                                               ___AVIAN RESCUE CORPORATION
            Corporation address: 1212 St Elizabeth Ct, Concord, CA 94518     (925)686-2350

                              BIRD SURRENDER FORM

   1. Bird Species (if known): ____________________________________________________
   2. Name: __________________________________________________________________
      Age: ______________________
   3. Sex (if known): ____________ How long have you have this bird: __________________
   4. Where did he/she come from to you: ___________________________________________
   5. If found: (a) where was the bird found: ________________________________________;
                 (b) when was it found (day/time):___________________________
   6. Do you know how many homes this bird has been in: Yes____ No____; number: _______
   7. Why are you releasing this bird: ______________________________________________
   8. Are you providing anything with this release (cage, food, ??): Yes____ No____
       ________________________________________________________________________
   9. Does the bird have any food preferences: Yes____ No____; if YES, what are they:
       ________________________________________________________________________
   10. Has the bird been to the Vet: Yes____ No____; if YES, when_______________________
       Results:__________________________________________________________________
   11. Is the bird on ANY medications: Yes____ No____; if YES, what are they (provide with
       the bird):_________________________________________________________________
   12. Known diseases: __________________________________________________________
   13. Bad habits (screaming, biting, attacking): _______________________________________
      _________________________________________________________________________
   14. Leg band: Yes____ No____; color/number:______________________________________
   15. Any other comments: _______________________________________________________
      _________________________________________________________________________

      I hereby relinquish all my/our rights and claims to the above bird

      Donor: ______________________________ Co-donor: ___________________________

      Signature(s): ___________________________ ________________________________
      Address: _________________________________________________________________
      Telephone: H: (    )_________________________ W: ( )________________________
      Email: ________________________________________
      Date: ________________________

Our web site: www.avianrescuecorp.org                      Avian Rescue, aka Cockatiel Rescue
(505) 899-5979, or (925) 686-2350                                                  03/16/09

				
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posted:7/13/2011
language:English
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