Adoption Application

St. Louis Avian Rescue (STAR)

Adoption Application

ANY APPLICATIONS NOT FILLED OUT COMPLETELY WILL NOT BE CONSIDERED!

Thank you for taking the time to complete this application form in its entirety.

The information provided will help us understand your home environment.

Do not hesitate to call with questions or assistance in completing this form. Please be as thorough and precise as possible.

We will be checking ALL veterinary references, and we ask that you notify your clinic so they can release information to our organization. We reserve the right to refuse an applicant.

Due to limited volunteer time, we review applications twice a month. Your patience is appreciated.

Approved applicants will be placed on our mailing list for updates and special events (program use only).

Our contract requires that if you cannot keep the bird for any reason, you MUST return the bird to our program.

Are you agreeable to this requirement?

Date:

Attention Out of the Area APplicants:

In special circumstances, we will consider out of the “area” adoptions. (By “area” we mean St. Louis City, St. Louis County, and surrounding Missouri and Illinois Counties.) Such placements are conditional on finding a rescue contact in your area to complete a home visit. Long distance calls will be returned collect. You must have a CURRENT avian vet and list 2 personal references at the end of this application.

If you live outside of the St. Louis area, are you willing to personally drive here to pick up the bird? _____

CONTACT INFORMATION:

Name:
Address:
City, State, Zip Code:
Home Phone:		Cell Phone:
Work Phone:		E-mail

What is the best way to reach you? ______________

RESIDENTIAL INFORMATION:

Type of residence: House Condo Apartment Other _____________________

Do you rent own ? How long have you resided here? _____________________

If renting or leasing, do you have the landlord’s permission to acquire a pet? __________

Landlord’s Name & Contact Information: __________________________________________________________

__________________________________ __________________________

How many people who reside in or visit your home smoke cigarettes or use other nicotine products? ___

FAMILY DEMOGRAPHICS:

Family members residing in home including yourself:

Name (including yourself)	Age	Relationship to you

Does everyone in your household know you are applying to adopt a bird? Yes No

Would you permit us to do a background check if needed? Yes No

Does anyone in your household have allergies or asthma? Yes No

Please tell us about your bird experience: ________________ _____________________

__________________________________________ _____________________

Are you aware that exotic birds may carry diseases that can infect humans? Yes No

Do you use scented plug-ins, air fresheners, candles, etc? __ _______

Do you use nonstick coated cookware? Yes No

EMPLOYMENT INFORMATION:

Are you employed outside of the home? Yes No If yes, full-time or part-time? ____________ ____

Occupation: _________________________ Name of Employer: _______________________________ ____

Address: _____________________________________________________________________________________ ____

STUDENT INFORMATION:

Are you a student? Yes No If yes, full-time or part-time?

School: Date of Graduation: _______________ ____

POTENTIAL BIRD INFORMATION:

What bird(s) are you interested in adopting? _____________________________________________________ ____

Why are you interested in adopting a bird?

Want a companion for self or family Want a companion for another pet Looks pretty, unusual

For breeding As a gift for someone Had one before/Have one now Other, please explain

What are the most important characteristics you are looking for in a bird?

Are you aware that birds might have or develop habits that could injure people and cause damage to property

(destruction of clothing or furniture, biting, screaming, dislike of certain people, droppings, etc.)? Yes No

If your bird develops a bad habit, what will you do? _____________ _________________________________________________________________

___________________________________________________________ _________________________________________________________________

Would you be willing to attend a class on bird care if available?

How did you learn about St. Louis Avian Rescue?

CURRENT BIRD INFORMATION:

Have you ever had birds?

If you no longer have birds, what happened to them? ___________

___________________________________________________________ _________________________________________________________________

Do you currently have any birds? Yes No If yes, please list:

Name	Species	Age	Sex - if known	How long have you had this bird?	Date of last vet visit

Who is/will be the bird’s primary caregiver? _________________________

When you go on vacation, who cares/will care for your bird(s)? _________

How often do you clean the cage? ___________________________________ ________________________________________________________________________ ________________________________________________________________________

How do you disinfect the cage? ______________________________________ ________________________________________________________________________ ________________________________________________________________________

How much time does your bird spend outside the cage each day? _______ ________________________________________________________________________ ________________________________________________________________________

How do/will you provide daily exercise and entertainment for your bird? _ ________________________________________________________________________ ________________________________________________________________________

How much time does your bird spend alone? __________________________ ________________________________________________________________________ ________________________________________________________________________

Do/Will you leave the radio, TV, or other audio/video on for your bird? __ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________

______________________________________________________________________

Describe your bird’s sleeping habits, including bedtime, wake-up time, nap time, and hours of sleep each day:

__________________________________________________________________ ________________________________________________________________________

________________________________________________________________________ ________________________________________________________________________

Describe your bird’s bathing habits, including frequency, likes, and dislikes: __________________________________________________________________ ________________________________________________________________________

________________________________________________________________________ ________________________________________________________________________

__________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________

What kinds of foods do you feed your own bird(s)?

Pellets Seeds Nuts Bird Treats Fruits

Vegetables Cooked Foods Table Foods Snack Foods

AVIAN VETERINARIAN INFORMATION:

If you live out of the St. Louis Area you must list an avian vet – if you do not currently have a vet, please list a clinic you intend to use.

Do you currently have an avian veterinarian? Yes No

If yes, please provide contact information. If no, please list who you will use.

Clinic Name:
Avian Vet’s Name:
Address:
City, State, Zip Code:
Phone:

How often do/will you take your bird to the vet?

CURRENT PET INFORMATION:

Do you currently have pets other than birds? Yes No If yes, please list:

Name	Species/Breed	Age	Spayed/ Neutered?	De-clawed?	Indoor or Outdoor	How long have you had this animal?	Date of last vet visit

Have you ever had any pets you no longer have? If yes, please explain the circumstances. ________________________________________

________

CURRENT VETERINARIAN INFORMATION (If different from Avian Veterinarian Information):

Clinic Name:
Vet’s Name:
Address:
City, State, Zip Code:
Phone:

VETERINARY INFORMATION RELEASE:

I hereby authorize the release of ALL medical records pertaining to the listed animal(s) to representatives of St. Louis Avian Rescue (STAR).

PLEASE READ CAREFULLY. This is not meant to intimidate you nor to cast a negative light on exotic birds. Rescued birds are no more and no less likely to behave in an aggressive or unpredictable manner than any others. But, STAR wants to make you aware of possibilities when working with them.

The birds STAR places have been surrendered, abandoned, or in some way displaced. They may have been abused or neglected. There may only be limited information available regarding their previous environment. STAR will share with you what information we have. There will be an adjustment period. Remember to be patient, consistent, and understanding.

Avian medicine is a relatively new discipline. It is possible for a bird to be a carrier of, or infected with, a disease that is undetectable with the current tests and tools available today. Therefore, you should quarantine any bird new to your flock. We recommend a period of at least 30 days – 90 would be even better.

If a bird is placed with you, you will be responsible for providing appropriate food, water, and loving attention. Many parrots have an extremely long life expectancy. Please think carefully about this. Are you ready to make this commitment?

I certify that I have never been charged with nor convicted of animal abuse or neglect in Missouri or any other state. I certify that no one in the household where this bird would reside has been charged with nor convicted of animal abuse or neglect in Missouri or any other state. (Please Initial)

I certify that any bird adopted will NOT be placed into a breeding situation. I certify that should I not be able to or not want to properly care for this bird, or in the event of my death, the bird will be returned to St. Louis Avian Rescue.

Signature: ___________________________________________ Date: _______________________________________________

Out of Area Applicants

Personal Reference One:

Personal Reference Two:

Please complete and e-mail to staravianrescue@gmail.com

Or mail to:

STAR

PO Box 732

Manchester, MO 63011

mjc • 8/08