Surrender Request Form - Exotic Avian Sanctuary of Tennessee

Your Name*

First Last

Your Email*

Your Age*

Address*

Street Address Address Line 2 City State ZIP Code

Phone Number(s)*

Avian Information

Bird's Name*

Species*

Age*

Sex*

How was sex verified?

How long in present home?*

How many known previous homes?

Please describe this bird’s diet (seed, pellet, fresh and cooked fruits and vegetables, etc,?*

Reason for surrendering this bird:*

Is this bird friendly?*

Yes
No
Not sure

Is this bird hand tame?*

Yes
No
Not sure

Is this bird aggressive?*

Yes
No
Not sure

Can this bird fly?*

Yes
No
Not sure

Does this bird prefer men, women, or no preference?*

Men
Women
No preference
Not sure

Does this bird like children?*

Yes
No
Not sure

Does this bird have any physical or emotional problems that we need to be made aware of to better provide for his/her care?*

Yes
No
Not sure

If yes, please describe in detail*

Has this bird ever been socialized with any other birds?*

Yes
No
Not sure

Please describe any likes or dislikes this bird may have

Please describe any favorite toys or activities this bird enjoys

Please provide any details about this bird that may be helpful in his/her adjustment to E.A.S.T

Veterinarian Care

Has this bird ever been seen by an avian veterinarian?*

Yes
No
Not sure

If yes, please explain in detail (well bird exam, illness etc):*

Veterinarian Name

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Consent*

I do hereby relinquish this bird to Exotic Avian Sanctuary of Tennessee for placement as they determine to be in the best interest of this bird. I understand that by signing this contract, I will have no cause or right to reclaim this bird and that Exotic Avian Sanctuary of Tennessee is the rightful owner and may retain the rights to make any and all decisions concerning this bird. This contract is not binding until your bird has been accepted and under the care of EAST, and an EAST representative has signed the contract.

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