Your Name:
Your Address:
City:
State:
Zip Code:
Your Telephone #:
The best time to call:
E-Mail address
Do you live in an apartment or condominium?	Yes No
If you rent, do you have permission from your landlord to own a pet bird?	Yes No
Do you work outside your home?	Yes No
If yes, how many hours per week?
Do you have any other pets?	Yes No
If yes, what kind?
Why do you want to adopt a bird?
How many birds do you now own?
What kinds are they?
Does anyone in your home smoke?	Yes No
What type(s) of birds are you interested in adopting?
Are you willing to take in an abused or neglected bird?	Yes No
Can you afford a cage/playpen for the bird(s)	Yes No
Where will the bird's cage be located?
Do you subscribe to any bird magazines?	Yes No
Do you plan to keep this bird for breeding or as a pet?	Breeding Pet
Are you a member of any Bird Club?	Yes No
Would you be willing to permit a post-adoption visit to your home?	Yes No
May we contact the veternarian you use?	Yes No
If yes, please list the name and telephone number.
Veterinarian's Name:
Veterinarian's telephone #
Tell me about yourself.

© Copyright 2005 - 2009 - My House of Wings.

Website Designed, Developed, and Maintained by