Flitesong Cage Bird Sanctuary

FLITESONG CAGE BIRD SANCTUARY

ADOPTION APPLICATION & CONTRACT

I, the undersigned, am adopting from Flitesong Cage Bird Sanctuary (abbreviated as FCBS) ________________________________________________________

___________ (type, name, and age of birds) for the purposes of

___ companion animal ___ breeder. I understand and hereby agree

that once I have accepted the transfer of said bird(s) FCBS as

indicated by my signature below, I accept the bird(s) as-is, as-seen,

with no guarantees with regard to health, age, gender, or behavior.

I waive any and all current or future claims, monetary or otherwise,

against FCBS for any veterinary or other costs that may arise as a

result of this adoption. I understand that FCBS is placing the bird(s)

with me in good faith and has informed me of any behavior or medical

problems that may be known at the time of this transfer.

___Band(s) is (are) on the bird(s) at the time of this transfer.

OR ___Band(s) was (were) previously removed and is (are) attached

to this surrender document. OR ___No band(s) was on the bird(s)

when transferred to FCBS. If known, the band number(s) for the

bird(s) is (are):_________________________________________.

____I agree to keep any and all of the bird(s) described herein for at

least one year from the date of transfer and agree that I will not

loan, sell, give away, or trade the bird(s) for at least one year after

they are transferred into my care by FCBS. I agree to provide

adequate food, water, shelter, light, ventilation, rest, play, and

caging appropriate to the size of the bird(s). I agree to seek medical

care and advice if and when necessary, at my own cost, to maintain

the bird(s) in the best of health. My avian veterinarian’s name,

phone number, and address are: ________________________________________________________

Applicant: Please put your initials by each section to indicate

your understanding and agreement:

____I will contact FCBS at the earliest opportunity if, for any

reason,I cannot keep the bird(s) and wish to return them to FCBS.

I understand that there might be up to a two week waiting period

to return the birds to FCBS to arrange for appropriate foster care

for the birds and that I will continue to maintain the birds in my

home until foster care is secured.

____If, after one year of adoptive ownership of these bird(s),

I transfer the FCBS bird(s) out of my home and/or into the care or

ownership of another person, I agree to notify FCBS within two

weeks of that transfer so FCBS is aware I have placed the bird(s)

in the care of another person. I will be sure such persons are

competent and caring as the new adoptive home for the bird(s) prior

to the transfer. Further, I will give the name, address, and phone

number to FCBS of the person(s) who received the bird(s).

I understand that FCBS will contact the person who received the

bird(s) to ascertain the welfare of the bird(s) and to offer assistance,

should the bird(s) ever need foster care or placement in the future.

FCBS will inform them that the stipulations contained herein regarding

proper animal husbandry and medical care when necessary also apply

in perpetuity to any bird(s) that anyone receives at any time during

the life of the bird(s) for any FCBS bird.

____I agree to allow FCBS to contact me at any time post-adoption

to inquire about the welfare of the bird(s) I am adopting today.

I also agree that an FCBS representative may conduct an onsite

inspection of the bird(s) in my home at any time during the first year

of my transfer, usually with at least twenty-four hours notice to me

prior to the planned site visit. If the FCBS representative determines

that the bird is in danger physically or is in ill health, they may

remove the bird(s) immediately and return said bird(s) to Flitesong

Sanctuary.

____I received the bird(s) described herein___ At no charge from

Flitesong Cage Bird Sanctuary.

___ I have reimbursed Flitesong Cage Bird Sanctuary medical costs

related to the care of the bird(s) prior to this adoption and have

received copies of any medical records and related bills.

___ I am making a monetary donation to FCBS to help in their work

with the birds of: ___ Check (check number: _______) ___ Cash ___

Other type of donation: _____________________

I ___ did ___ did not receive a cage with this bird.

If yes, type/size: ______________________

_____ The cage was free ___ OR ___ I made a cash donation of: __________________________

I ___ did ___ did not receive a playstand with this bird.

If yes, type/size: ___________________

_____ The playstand was free ____OR ____I made a cash donation

of: _____________________

I ___ did ___did not receive ___ food supplies for the bird(s).

If yes, please describe:____________________________________

I ___did ___ did not receive toys for the bird(s). If yes, please

describe:

____ (IF APPLICABLE TO THIS ADOPTION) The bird(s) described

herein have special medical needs that have been explained to me.

I promise to provide any prescribed medication or medical protocol

or treatments for the bird(s), for however long this is needed as

determined by a qualified avian veterinarian. I also promise to provide required and appropriate follow-up home care and

subsequent avian veterinarian care entirely at my cost, for the life

of the bird(s), whenever needed to maintain the health and happiness of the bird(s).

____ (IF APPLICABLE TO THIS ADOPTION) The bird(s) described herein have special physical needs that have been explained to me. And I promise to provide supportive follow-up home care and subsequent avian veterinarian care entirely at my cost, as well as suitable perches, caging, or other equipment as required, for the life of the bird(s), whenever needed to maintain the health and happiness of the bird(s).

I hereby agree to adopt the bird(s) described herein according

to the FCBS Adoption Contract requirements and have received the

bird(s) this date: ______________________

Name of Adopter: _______________________

Signature: ________________________

Street Address, City, State, and ZIP: __________________________

__________________________________________________________

Telephone Numbers:

Home: ( ) _________________

Work: ( ) _________________

Cell:________________________

Name and Contact Information for Nearest Relative or Friend if