Thank you for applying to adopt a bird from CPR!Please fill out the form below and you will be contacted directly by the volunteer coordinating your home visit. Please be aware that CPR has the right to deny any adoption without cause. I, , do hereby relinquish a , named to Companion Parrots Re‐Homed on . I understand that the parrot I am relinquishing will be the sole property of CPR. I also understand that the parrot being relinquished will be examined by a veterinarian and that CPR has full authority to make medical decisions which are in the best interest of the bird. It is asked that the owner relinquishing the bird help cover the cost of veterinary fees, which can run up to $200, whenever possible. A tax deductible receipt will be provided for donations to offset vet expenses. Inability to donate does not disqualify the bird from entering the program. In addition to the parrot listed below I understand that if I donate the bird’s cage and accessories, these items become the sole property of CPR. I agree to furnish to CPR the information below to assist with the adoption process and minimize stress to the bird during the forthcoming transition period. Background Information Why are you surrendering the bird?* What is the age or approximate age of the bird?* What was the bird’s age when acquired by you?* If you are not the first owner, what do you know about the previous owner(s)? How did you acquire the bird?* How long have you had this bird?* What is the gender of the bird?*MaleFemaleUnknown Health and Care Information When was the last time the bird visited a veterinarian? Date: Why was the bird seen? What procedures were performed? What was the name of veterinarian? Do you have copies of the records?YesNo Are there any known health concerns and if so, what? Did or do you or anyone in your household smoke?YesNo List the age and gender of the other members of your household. Are there other pets in the household? Please list. Are there any behavioral issues and if so what? Has the bird been around other birds at any time (boarding, visiting friends, etc.)?YesNo If YES selected how long ago was the exposure What food(s) has the bird been eating? What is the size of the bird’s cage? What words or phrases does the bird say? What sounds/whistles does the bird imitate? Any other special qualities about your bird? Explain the bird’s daily routine. Do you shower the bird? If so, explain how and how often.YesNo How often? How? Did the bird have a “favorite person” and if so, who? Does the bird show preference to:MenWomenBoth Is the bird’s cage covered at night?YesNo Can you make a tax deductible donation to cover vet bills for your bird?YesNo Will you donate the bird’s cage and accessories? If so, please list items. Name Date of Surrender Address City State and Zip Code Telephone Email Address