Relinquishment
We understand that this form is long. The job ahead of us is a longer one and we all the information that you can provide us. This will help us to do our best for this precious life entrusted to us.
It is our policy to keep tabs on all birds that we adopt to new homes.
LEGAL INFORMATION, PLEASE READ: Our online relinquishment form helps us to place your bird. The form is a legally binding contract but only after we pick up the bird and it becomes our “rescue bird.” The form does not require you to surrender the bird at this time. You can choose whether or not to do this at the appropriate time.
Thank you for taking the time to complete this relinquishment form in its entirety. The information provided will help us understand your bird's needs. Please do not hesitate to call (760-645-3972) with questions or assistance in completing this form.
Please contact your veterinarian for complete medical records, if available, and present them at the time of relinquishment.
As a matter of policy we do not refuse birds based on behavioral problems.
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First Name
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Last Name
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Street Address
Address Line 2
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City
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State
Alabama
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California
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Connecticut
Delaware
Florida
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Hawaii
Idaho
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Indiana
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Maryland
Massachusetts
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New Hampshire
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New York
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Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
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Zip Code
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Phone Number
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Email Address
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Bird's Name
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Species:
Hatch date (if known)
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Where and when did you aquire your bird?
0/255 characters
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Please provide contact information for your bird's breeder, pet shop, or previous guardian:
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Why are you considering relinquishing your bird to The Chloe Sanctuary?
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Would assistance with education or behavior modification be a possibility as a means for you to keep your bird?
Yes
No
I would like to discuss it with someone
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Please explain your answer to the above.
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Are you the legal "owner" of the bird?
Yes
No
THIS CONTRACT IS LEGALLY BINDING THE DAY THAT THE BIRD(S) IS PHYSICALLY HANDED OVER TO THE CHLOE SANCTUARY FOR PARROTS AND COCKATOOS. THE "OWNER" ACCEPTS THESE TERMS FOR THE DAY OF RELINQUISHMENT.
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I hereby authorize the release of ALL medical records pertaining to the above listed bird(s) to representatives of The Chloe Sanctuary for Parrots and Cockatoos. I have a legal right to do so.
I authorize the release of records
I do not authorize the release of records
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PLEASE READ THE FOLLOWING CAREFULLY. THIS IS A LEGALLY BINDING CONTRACT.
I hereby agree to relinquish to The Chloe Sanctuary for Parrots and Cockatoos the above listed bird(s) to be placed in the shelter adoption/placement program. I relinquish all claims to the above listed bird(s) and any future progeny
upon pickup or delivery of the bird to The Chloe Sanctuary for Parrots and Cockatoos
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I realize that
I am the sole provider for the bird(s) named above
until it is picked up by or delivered to The Chloe Sanctuary for Parrots and Cockatoos. Once I have turned the bird(s) over to The Chloe Sanctuary for Parrots and Cockatoos this contract shall be legally binding.
I agree to release all rights
I do not agree to release all rights
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I affirm my digital signature by typing in my full name here:
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Please choose today's date from the calendar as the date of signature.
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A copy of this document will be provided to the adopting party. lf you wish the us to withhold
your name and contact information, please check the appropriate box.
I approve
I disapprove
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HEALTH INFORMATION
Please give us the name of your Avian veterinarian. If you do not have one enter "NONE."
We also need the clinic name, address, phone number, and fax. This will help us to care properly for the bird(s).
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How often do you take your bird to the vet?
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When was the last visit? What was the reason for it?
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Describe your bird's overall physical condition:
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Please check all that apply:
The bird is banded
The bird is microchipped
The bird is DNA registered
NONE OF THE ABOVE
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Provide band number, brand of microchip and the name of the DNA registry, if applicable:
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Please check all that apply
The bird has sustained injuries.
The bird has had surgery.
The bird has been treated for a disease.
The bird has taken medications.
The bird has been on herbal or other altemative therapy.
The bird has medical/physical conditions that requires treatment and/or a specialized housing/play area.
Please explain any checked item above:
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DIET
Describe your bird's current daily diet:
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Favorite foods:
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List the foods your bird currently eats, including specific food names and brands: [please be as complete as possible]
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BEHAVIOR
Is your bird comfortable with being handled?
Yes
No
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Please explain your answer:
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Are there any other birds or pets in your home?
Yes
No
If yes, please list:
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Does your bird interact with other birds or pets?
Yes
No
If yes, please describe:
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Does your bird like children?
Yes
No
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Please explain:
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Does your bird like visitors in the home?
Yes
No
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Please explain
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Does your bird have any known behavioral problems? Please check all that apply. If no problems are known then check NO BEHAVIORAL PROBLEMS.
NOTE: Behavioral problems do not deny your bird our rescue services. We need to know these in order to properly care for a bird. It is our policy to never refuse a bird based on behavioral issues.
screaming (not normal am or pm calls)
plucking
chewing
biting
pacing or other habitual action
agression other than biting
other
NO BEHAVIORAL PROBLEMS
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Please explain:
Please tell us anything else you believe we might need to know to make this bird happy and healthy:
Last comments:
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