The Charlie Brown Bird Rescue Surrender Contract

Before you begin filling in your contract, please read the surrender page of the website. We do not take parakeets, budgies, canaries, doves, pigeons, ducks or chickens.

If you need to surrender a parakeet or budgie, we recommend contacting A Little Budgie Told me. Here is their FaceBook rescue link.

The contract below assumes that The Charlie Brown Bird Rescue will be taking responsibility for a parrot that was in your care. A monetary donation is not required; however, medical testing, food, toys, etc., add up quickly. We very much appreciate any donation you can comfortably make. ** All donations are tax-deductible!!

Please complete this application as thoroughly as possible. The more information you provide, the quicker we can respond. Once we receive your application, you will receive a phone call from an 440 area code. And you will also receive a text if there is no answer from our volunteer surrender coordinator.

Go back

Your message has been sent

The following information will help us to provide the best possible care for the bird you wish to surrender. Please fill out this form to the best of your ability.

I, (type your full name in the text box below)

do hereby surrender ownership of (type bird’s name and species in text box below) to The Charlie Brown Bird Rescue for placement as they determine to be in the best interest of the bird.

I understand that by signing this contract (click the radio signature button below), I will have no cause or right to reclaim this bird and that The Charlie Brown Bird Rescue is the rightful owner and may retain the rights to make any and all decisions concerning the bird. I also confirm that I’m the legal owner of the bird and have the right to sign this contract.(required)

Signature

Today’s Date (YYYY-MM-DD)

Owners Name (First and Last)

Owners Address

Owners City / State / Zip Code

Owners Phone

Owners Email

Bird’s Name

Species

Identifying Marks

Age

Sex(required)

Male Female Unknown

Has the bird’s sex been verified?(required)

Yes No

Band/Microchip Number

Why are you surrendering your bird?

Where did you obtain the bird?

When did you obtain the bird? Date (YYYY-MM-DD)

How many previous homes was the bird in?

What do you know about the previous home(s)?

Tell us about your bird’s personality and behaviors.

Please describe the bird’s diet (seed, pellet, fresh foods such as fruits and vegetables etc.) Also, please list brands if possible.

What are the bird’s favorite foods?

Does this bird fly? If so, where?

Does this bird have any daily routines that they are used to? If yes, please describe.

Has this bird ever been seen by an avian veterinarian? If yes, please explain in detail (well bird exam, illness, etc.)

Has this bird ever been diagnosed with a disease or problem? If yes, explain in detail.

And physical deformities or special needs? If yes, please explain in detail.

How did you hear about us?

As part of the surrender, we would like to contact your avian veterinarian for the bird’s records. I hereby authorize the release of ALL medical records pertaining to the above-mentioned bird to The Charlie Brown Bird Rescue and its representatives. What is the name of the veterinarian clinic used?

Address

City/State/Zip Code

Phone and/or Fax Number

By clicking the radio button below, you are giving permission for The Charlie Brown Bird Rescue to contact your avian veterinarian for the bird’s medical records.(required)

Signature

Signature Printed Full Name

Today’s Date (YYYY-MM-DD)

Your message has been sent

Share this:

Like this: