Adopt-A-Bird Program
EMERGENCY PLACEMENT APPLICATION
Electronically:
Fill out and then copy and put into an e-mail to Leanna at leannarein@hotmail.com
By
Mail: P.O. Box 101825, Anch, AK 99510
Contact: Leanna
We
appreciate the invaluable service that emergency placement provides. We
want to make the most informed decision regarding which animals to place in
your care. Completing this application is the best way to assure a
positive experience for both you and the animals. This is not a
foster application. Birds in emergency placement can be placed and then
moved immediately to a foster home or out for adoption if the Adopt-A-Bird
Committee sees fit and it can take up to 30 days to resolve a foster home or adoption,
so Emergency Placement can be for as long as thirty days. A home
inspection by a committee member is required.
Name:
Address:
Phone
#
Daytime: Evenings:
E-mail:
Type(s)
of parrots you are prepared to take (species types, size types, etc):
_________________________________________________________________________________
(More
often than not, this may mean that we call you and come over with a bird within
an hour as it will have already been an ÒemergencyÓ). ItÕs important to
know if you are prepared or not.
Do
you currently have birds in your home:
Yes ____ No ____.
If
yes, have they all been vet tested (for contagious disease) in this past
year? Yes ____ No _____
and
can you please describe what a quarantine area means and how you can accomplish
this?
_________________________________________________________________________________
_________________________________________________________________________________
and
do you have forced air heating or baseboard heating in your home:
Forced
Air ____ Baseboard Heating: ______
If
you answered no, can you describe what experience have you had that would be
helpful in caring for a parrot on a moments notice?
________________________________________________________________________________
Do
you have any experience training and working with parrots with behavioral
issues?
Yes
___ No ____
If
yes, please explain.
______________________________________________________________
Do
you live in a: House ___ Apartment
___Condo ___Other_
If
you rent, does your landlord allow birds in particular? Yes ____ No
_____
Do
you have cages available? Yes ____ No _____ What sizes?
____________________________
Are
there any children in your household?
Yes _____ No ______If yes, what are their ages?_____
Are
there any animals in your household?
Yes ____ No ____ If yes, what kind and how many: ___
Do
any members of your household have allergies? Yes ____ No ______
Where
do you plan to keep your placed parrot in regards to area of house i.e: kitchen,
living room, garage, etc :
_______________________________________________________________________________
________________________________________________________________________________
How
many hours per day will the placed parrot be without adult care? _______
Can
you financially provide care for this parrot if it were to become ill or
injured: Yes ____ No ____
(as
a placement home, you would be required to report any illness or injury as soon
as you become aware of any to a bird club committee member within 24
hours)
Have
you had any parrot deaths in your home in the past 2 years? Yes ____ No _____
If
yes, please explain?
Can
you accept the fact that some animals will not survive or may have to be
euthanized and that this decision is up to The Alaska Bird Club President and
Adopt-A-Bird Chairperson?
Yes____
No ____
Do
you understand that anyone interested in adopting your placed parrot (including
yourself) must go through the standard adoption process, and through an
approval of candidates and the ultimate placement of the parrot/s is up to the
The Alaska Bird Club? (Of course, we welcome your referrals)
Yes
__No ___
I
have answered the questions above truthfully and completely. I understand
that although The Alaska Bird Club takes reasonable care to screen parrots for
emergency placement, it makes no guarantee relating to the animalsÕ health,
behavior or actions. I understand that I receive emergency placed
animals at my own risk and can reject or return any animals for which The
Alaska Bird Club has asked me to provide care. I indemnify and hold The
Alaska Bird Club and itÕs officers free and harmless from all liability arising
out of any and all claims, demands, losses, damages, action, judgment of every
kind and description which may occur to or be suffered by me, members of my
household, or any third parties by reason of activities arising out of this
agreement.
_____________________________ADL#
___________________ Date ___________________
Signature
(Print as well ________________________)
Return
application to:
The Alaska Bird Club P.O. Box 101825
Anchorage, AK 99510-1825 email: akbirdclub@yahoo.com
Contacts:
Leanna Rein 868-7878, Cindy at (907) 357-2513.
For Bird Club use only:
Approved: Yes ____ No
____ Adopt-A-Bird
chairperson
initials:_________________________
Date:___________________________
Comments:
_________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________