| Name*: | |
| Age*: | |
| Spouse Name: | |
| Address*: | |
| City*: | |
| State*: | |
| Zip*: | |
| Email Address*: | |
| Home Phone*: | |
| Work Phone: | |
| Cell Phone: | |
| Why do you want to adopt a bird?: | |
| Have you ever owned a pet before? : | |
| Please describe the pets that are currently with you (type, age, sex, altered status).: | |
| Are all other pets current of all vaccinations?: | |
| Are other pets spayed/neutered?: | |
| If no to either, please explain:: | |
| Are other pets on heartworm preventative, if yes what brand? : | |
| If no, please explain:: | |
| Please describe those pets that are no longer with you (type, age, sex, altered status).: | |
| What happened to the pets who are no longer with you?: | |
| Please provide your veterinarians name & phone number:: | |
| How many people reside in your home? : | |
| Number of children living at home & ages: : | |
| Do you have young children visit on a regular basis? If yes, what ages?: | |
| Does anyone have allergies? : | |
| Is everyone in your home agreeable to adopting a bird? : | |
| If not, who and why:: | |
| Who will be responsible for feeding and training the bird?: | |
| What is the main food you will be feeding the bird?: | |
| How would you handle unwanted behaviors (Screaming, plucking, etc)?: | |
| Which of the following term (s) best describes your current living situation: : |
|
| If other, please explain: | |
| If you rent, please provide landlord’s name & phone number:: | |
| How long have you lived at this address? : | |
| Does anyone in your home smoke?: | |
| If yes, where at in the house?: | |
| Birds can require a lot of attention and maintenance, have you considered this?: | |
| What variety of foods would you feed to an exotic bird?: | |
| How do you plan to train your bird?: | |
| Are you familiar with the type of bird you are interested in adopting, and if not are you willing to research his/her care?: | |
| Will the bird be left alone during the day?: | |
| If yes, for how long? : | |
| Where will the bird be kept when you are gone? : | |
| Where will the bird be kept when you are home? : | |
| Will you allow your bird out of his cage?: | |
| How frequently will the adults be gone away from home on business/vacation/trips?: | |
| If you have preference of male or female or age range, please specify : | |
| Please list the bird that you are currently interested in: : | |
| Please provide the name, address, and phone number of three references and their relationship to you:: | |
| How did you hear about BARK?: : |
|
| If other or another shelter/rescue, please specify:: | |
| All potential adoptions require a home visit, do you consent to this in the event that the application is approved? : | |
| If no, why not?: | |
| Applicant’s signature: : | |
| Date: | |
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