An Educational Pet Bird Club & Rescue
501(c)3 Non-Profit organization
EIN: 77-0630832
9010 Rosehill Rd., Ste. B., Lenexa, KS 66215 913-322-3398
adopt.BNW@gmail.com beaknwings.org
Single bird surrender form Office Use: Bird Number ______________________________
One ( 1 ) bird per surrender form
Thank you for taking the time to complete the Surrender Form in its entirety. The information provided will help us understand your birds' needs. Please do not hesitate to call with questions or assistance in completing this form. If placement is the only alterative for you, contact your veterinarian for complete medical records and return to Beak n Wings.
What are you doing today?*
Owners First name*
Last name*
Are you willing to have possible adoptee/adoptee call you about the bird you are surrendering? This is NOT required.*
Upload Drivers License/ID Card*
I declare that I am the current and rightful owner of Bird Name (only one bird per surrender form) I agree to relinquish ownership and all rights to the below listed animal (bird). As of this date listed above the described animal belongs to Beak n Wings, Inc., to do with as necessary and humane.
Bird Species (i.e. Cockatiel, Amazon, Macaw)*
Please upload a couple of good pictures of the bird you are surrendering *
Veterinary Information: I hereby authorize the release of all medical records pertaining to the above listed bird to representative of Beak n Wings.
Address, City, State, Zip Code
Veterinarian Phone Number
Please type your digital signature below. By signing, you are giving Beak n Wings permission to to obtain all medical information from listed veterinary listed above.*
When did you acquire your bird?*
DNA Sexed? (if DNA sexed, can you provide certificate)*
Does your bird step up on command?*
Has your bird ever laid an egg?*
Check all that apply as reasons for giving up your bird*
If other, please explain.
Has your bird had any of the following?*
If yes, please explain here.
Health: Have you had a bird die in your home?*
If yes, explain why and how here.
Have you ever had a bird tested positive for any viruses such as Bornaviruse, Beak & Feather?*
Please understand Beak n Wings does not take in sick birds. If for some reason the surrendering party was not truthful with Beak n Wings on this form, phone, text, or email we could end up putting the bird down, depending on the illness. Beak n Wings does not have the funds to treat unwanted birds due to illness.
Many viruses, bacteria will transfer from bird to bird via air,, waste, eating, or drinking after each other, living in the same cage. Please be aware that if you have or had a sick bird, that does not mean every bird is sick, but Beak n Wings really needs to know if there is or was a sick bird in the home so that we do not place the bird in a foster home taking a chance of infecting even more birds. Please be honest when filling out the surrender form so that we can better protect our other birds.
If you have had a sick bird at some point, this does not mean we will not take the bird. We prefer the bird if sick less than six (6) months have a vet send a health certificate stating the bird appears to be healthy.
Behavior: Mark all that apply*
Does the bird say bad words?*
Explain your answers from above.
Does your bird have a favorite food? Explain below. If no type NO.*
Sleeping habits, (explain below if needed)*
Cage/Perches/Toys - Describe your bird's cage*
Explain Bathing if needed.
Who is your bird's primary caregiver?*
Describe your bird's playtime activities*
Does your bird have night frights? If yes, explain below below*
Explain night frights if needed.
How many hours a day does your bird spend home alone? Explain if needed*
Do you leave the radio, TV, other audio/video on for the bird?*
Please tell us more about the bird that we might not have listed
List any changes within your household that may have contributed to the above behavioral problems*
Why are you considering placement of your bird with Beak n Wings?*
Would assistance with education or behavior modification be possible as a means for you to keep your bird?*
If yes or no, please explain
By signing below I have filled in the form honestly and to the best of my knowledge*
Beak n Wings Representative Signature & Date
Beak n Wings Representative Printed Name
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