BOARDING INFORMATION FORM
Please print each page (there are 2) and bring them with you filled in when you bring a bird to us. It will help make BOARDING YOUR BIRD much more comfortable and happier here.{Print by copying and pasting into Microsoft Word. You can fill it in and print from there. Or feel free to fill out by hand after printing.}Forms can be emailed by attaching Microsoft file to your email, or sent by USPS to S.E. Iowa Parrot Rescue 3554 270th Avenue Keokuk, IA 52632.
Bird Information
Date: ________________
1. Bird's Name: _____________________________________
2 Species: _________________________________________
3. Age: _______________ Date of Birth: ________________
4. Gender [ ] Male [ ] Female [ ] Unknown
Microchip? [ ]YES [ ]
Leg Band Present? [ ]YES [ ] NO #________________
Tattoo? [ ] YES [ ]NO
5. Weight on intake: _________
6 Previous medical issues if any: _____________________________________________________
6. Current medical issues if any: _____________________________________________________
7. Veterinarian used: _________________________________________________________________
8. Food habits – preferences/dislikes: _________________________________________________
9 . Bathing habits (spray? bathe itself? frequency?): ___________________________________
10. History with other birds: _________________________________________________________
11. Sleeping habits (bedtime? covered? night frights?) _________________________________
12. Likes and dislikes (gender preference in people, Favorite toys: ______________________________________________________________________________________________________
13. [ ] Flighted? [ ] Has ever flown? [ ] Wings clipped?
Owner information:
Name: _____________________Address: ______________________________
City:___________State:____ Phone:____________________
Email:_______________________________________________
South East Iowa Parrot Rescue and ___________________ (hereafter "Owner") agree that the following bird: (Name) ________________________, a (Species) __________________ is boarded under the following conditions:
1. Owner states that the bird has no known diseases or disabilities other than ___________________________________________________________________________________ .
2. Owner states that they are legally in possession of the bird and have the right to place it, and that no other person has any legal or financial claim on the bird.
3. Owner agrees that they have received no promises or inducements from South East Iowa Parrot Rescue except those included in this agreement.
4. Owner agrees that they are voluntarily placing bird at South East Iowa Parrot Rescue for the purpose of boarding said bird.
5. South East Iowa Parrot Rescue agrees that the bird will at no time be sold, traded, or in any other way disposed of for any reason without Owner’s written permission.
6. South East Iowa Parrot Rescue agrees to maintain the bird in healthy and safe conditions, according to generally accepted standards.
7. South East Iowa Parrot Rescue agrees to board the bird at a fee of $10.00 (Finch, Canary, Cockatiel, LoveBird,Parakeet, Parrotlet), $20.00 (Conures, Senegals, Mini Macaws) or $30.00 (African Grey, Amazons, Cockatoo, Macaw, Mynah)per bird/per week so that we can provide adequate care, to include housing, toys and diet. Veterinary care, if needed, is charged to the owner. Owner will always be notified if Veterinary care is needed, unless an Emergency arises.
8. Owner has the right to refuse Veterinary care recommended by Rescue personnel, in which case Owner shall remove the bird immediately from Rescue premises. South East Iowa Parrot Rescue is not responsible for illness, injury or death unless due to neglect or direct action of Parrot Rescue employees to boarded parrots. p>
9. South East Iowa Parrot Rescue and Owner agree to mutually release and absolve each other from all future claims, except those arising from breach of this contract.
Ann M. Wykowski ________________________________ South East Iowa Parrot Rescue
DATE ___________
Owner_____________________________
Address _____________________________
City _______________________St______
Phone ______________________________
Phone while Boarding_________________________________
Email _____________________________
Boarding start date: _____/_____/,2014,2015,2016 Boarding End Date ____/_____/ 2014,2015,2016.