**This application is confidential**
*Answering yes or no to any of the questions below will not necessarily result in your qualification/disqualification as an adopter*

(Please print clearly and mark N/A for any item not applicable to you)
Our Policies
1). We interview all applicants for all adoptions
2). We reserve the right to turn down any applicant
3). Adoption fees are based on type of adoption
4). All adopters must have a veterinarian
5). We adopt out all our birds as companions and not for breeding purposes.
6). We will take back any adoptee within the first three months, minus a percent fee.

Date _______________________
Personal Information:
First Name _____________________________ Last Name _____________________________________
Address _______________________ City _____________________
State __________________ Zip _____________
Home Phone Cell Phone
Email
Residence Information:
House __ Condo __ Townhouse __ Apartment ____ Other_______
Own ___ Rent/Lease ___ Live with Parents ___ Other
Does your lease list parrots as acceptable pets? Y N
Do you have permission from your landlord to have a parrot? Y N
Household Information:
Number of Adults Number & Ages of Children ____________________________ _____________ ______________ _____________ ________________ _____________
Do all members of your household know that you are applying to adopt a bird? N Y
Does anyone in the household have allergies or asthma? N Y
Do you understand that some birds (cockatiels & cockatoos especially) have more dander than others and can make asthma or allergies worse? Y N
Does anyone in the house smoke? No Y
Where do you smoke? Outside Separate room
Do you understand that second hand smoke can shorten a bird’s lifespan? Y N
What types of plants do you have in your home? ______________________________________________________________________________
Do you understand that some plants are poisonous to parrots? Y N
We will provide you with a list of toxic and safe plants for birds.
Do you use Teflon cookware? Y N
Do you understand the dangers of toxic fumes from Teflon? Y N
The kitchen is an unsafe place for parrots due to fumes from Teflon, self-cleaning ovens and other dangers.
Do you use air fresheners, scented candles, or rug cleaners in your home? Y N
Do you understand the dangers of toxic fumes from candles, (soy based, non lead wick candles are safe) air fresheners, or rug cleaners? Y N
Do you have other pets? Please list how many and what type. ____________________________ _____________ ______________ _____________ ________________ _____________
General Information
What type of parrot would you like to adopt? ______________________________________________________________________________
If you’ve seen this bird on Petfinder.com or another website what is this bird’s name? ______________________________________________________________________________
Why are you interested in adopting a bird? ______
What type of experience do you have with birds? ______________________________________ ______________________________________________________________________________ ______________________________________________________________________________
If interested in adopting a large bird, macaws or cockatoos, you must have experience with these large birds.
Who will be the primary caretaker of the bird?
Who will care for the bird when the primary caretaker is away? ______
Is this a qualified caregiver? Y N
How many hours a day would this parrot be left alone?
How will you provide daily exercise and entertainment for your bird? ______
What other types of birds do you currently have in your home? ___________________________ ______________________________________________________________________________
*Do you breed birds? What type? ______________________
This will not affect your application.
Do agree not to breed this particular bird? Y N
Have you ever given up a bird for adoption or given a bird away? What was the reason? _________________________________________________________________ _________________________________________________________________
*See adoption policy- we do not adopt out birds for breeding purposes.
What circumstances, in your mind, justify giving up a bird? Moving New Baby Divorce Chewing Furniture Behavioral Problems __ Messy ___ Time Consumption Allergies Medical Problems___ Aggressiveness __ Not Getting Along with Other Pets Screaming Feather Plucking Other
Home Environment
Where will this parrot's cage be located? _____________________________________________
What size cage do you have for this bird? ____________________________________________
Canaries and Finches – minimum cage requirements-18x12x12
Parakeets and English Budgies – minimum cage requirements-18x12x12
Cockatiels, Conures, Lovebirds and Parrotlets– minimum cage requirements-18x18x18
Lories and Lorikeets– minimum cage requirements-18x12x12
Quaker parakeets– minimum cage requirements-30x30x30
African Greys, Amazons, Smaller Cockatoos– minimum cage requirements-34x44x36
Macaws (small) – minimum cage requirements-34x44x36
Macaw and Cockatoo – large-– minimum cage requirements-48x34x60
Behavior
Are you aware that birds might have or develop bad habits (destruction of clothing, furniture, drapery, etc; biting; screaming; dislike of strangers or certain household members), and that these habits can be difficult to break? No Yes
Are you aware that all parrots have a natural urge to scream and should be allowed to do some screaming, (morning and evening is a natural instinct for screaming. These are called flock calls) Y N
Some types of parrots (macaw sand cockatoos) may scream longer and louder that others. Family members and neighbors could be bothered by the noise. Is this something you have taken into account when deciding on a bird? Y N
Are you aware the it is a natural instinct for parrots to chew wood, buttons, clothes, and anything else they find interesting and this is a normal and not a bad behavior? Y N
Do you understand that some parrots may not like children and will attempt to scare your bite children in your home? Y N
Some parrots may also have problems with noise and the general chaos with children in the home.
Do you understand your parrot can become sexual bonded to one member of your household and will bite the other member out of jealousy? Y N
What if any experiences do you have with parrot behavior? ______________________________ _________________________________________________________________ _________________________________________________________________
If your bird develops a bad habit what will you do?
Do you subscribe to any magazines, webzines, webgroups, or belong to any parrot clubs? Please list _________________________________________________________________ _________________________________________________________________ _________________________________________________________________
Veterinarian and Health Care
Do you have a qualified avian veterinarian in your area? Y N
Are you a client of this veterinarian at this time? Y N
Avian Veterinarian ______________________________________________________________
Address _________________________________________________________________
Phone _________________________________________________________________
Every pet needs a yearly wellness check, are you willing and able to provide one? Y N
Do you have a veterinarian for your other pets? Y N
Name _________________________________________________________________
Address _________________________________________________________________
Phone ________________________________________________________________
Nutrition
Have you done any research into parrot diets? Y N
Our parrots are all a base diet, which consists of natural Zupreem and Mazuri pellets, vegetables, fruits, cooked rice, pasts, grains, meat, juices, and herbal teas. We use organic as much as possible. This diet is more expensive and time consuming but healthier for your parrot. Will you be able to continue this type of diet if we place a parrot with you? Y N
How did you hear about our adoption program?
Adopted from F5RS before Web Site (www. F5RS. petfinder.com) Friend/family___ Other
By signing below, I am attesting to the truthfulness of my answers. Falsification of any of the above information will be grounds for disallowing the adoption of an F5RS bird and possible removal of an adopted bird from the home. F5RS reserves the right to refuse any applicant.
Please be aware that we may have little or no information on the pet you are interested in and cannot guarantee health or temperament of the pet you choose. Signature _________________________ Date