Adoption Application

Date: ____________________

Name : ________________________________________________________

Address: _______________________________________________________

City, State, ZIP: __________________________________________________

Phone: ( ) _________-____________ Email ______________________________

Age: ___________ Gender [ ] Male [ } Female

Employment: ________________________________________________________________________

Children/ages: ___________________________________________________________________________ ______________________________________________________________________________________

Does anyone in your home have allergies? __NO __YES If yes, To what? :___________________________________________

Does anyone in the house smoke? (not "does anyone smoke in the house?") [ ] YES [ ] NO

Other pets in the house. ______________________________________________________________

How many hours a day will the bird be alone? (Not including sleeping)_________________________________

What room will the bird live in? ______________________________________________

Do you use the internet? [ ] YES [ ] NO What for? _____________________________________________________________

Ever have a bird die or fly away? What happened?___________________________ _________________________________________________________________________

Do you have access to an avian veterinarian? [ ] YES [ ] NO ____________________________________

Previous experience with companion birds: ______________________________________________________ _____________________________________________________________________________________

Reason for wanting a bird: _________________________________________________________

What kind/species of bird are you looking for? _______________________________________

Anything else you think we should know? _____________________________________________

WE WILL NOT BROKER THE SALE OF A BIRD.

A few things to be aware of:

1. We seldom place birds with smokers.

2. We never ship birds anywhere.

3. We never place a bird with someone we haven't met, interviewed, and visited with, here, or in their home.

4. We never intentionally place birds in breeding situations. There are too many unwanted birds now.

5. If you adopt from us, you will sign a legally enforceable contract.

Bird Links

South East Iowa Parrot Rescue
Placing A Parrot
Intake Form
Contact Us
Available Birds
Adoption Contract

Email: keokukbirds@msn.com