Gainesville Cockatiel Rescue Adoption Application

1. General Information: Please type your full name, address, phone number and e-mail address below.

General Information: Please type your full name, address, phone number and e-mail address below. First and Last Name
Street Address
City
State
Zip code:
Phone Number
Cell Number
E-mail Address

2. Do you own your home? If not, does your land lord allow pets (birds specifically)?

Do you own your home? If not, does your land lord allow pets (birds specifically)?

3. Household Questions:

Household Questions: Does anyone in your household smoke?
Does anyone in your household have allergies?
Are you the person who will be caring for the bird(s)?
Are you over 18 years of age?

4. Do you pets in your home currently? Please indicate type and number.

	0	1	2	3	4	5+
Birds	Do you pets in your home currently? Please indicate type and number. Birds 0	1	2	3	4	5+
Reptiles	Reptiles 0	1	2	3	4	5+
Dogs	Dogs 0	1	2	3	4	5+
Cats	Cats 0	1	2	3	4	5+
Rodents	Rodents 0	1	2	3	4	5+
Other	Other 0	1	2	3	4	5+

Add any additional comments about your pets here.

5. Do you have any children in your household? If Yes please select number.

	0	1	2	3	4	5
Number of children	Do you have any children in your household? If Yes please select number. Number of children 0	1	2	3	4	5

Ages of Children

6. What experiences have you had with pet birds, either your own or with those owned by other people? Why do you want a cockatiel (or other bird) for a pet?

What experiences have you had with pet birds, either your own or with those owned by other people? Why do you want a cockatiel (or other bird) for a pet?

7. What type of bird(s) are you interested in adopting?

	Yes	No
Female Cockatiel	What type of bird(s) are you interested in adopting? Female Cockatiel Yes	No
Male Cockatiel	Male Cockatiel Yes	No
Pair of Cockatiels	Pair of Cockatiels Yes	No
bird(s) with a disability	bird(s) with a disability Yes	No
Bird(s) that are Tame	Bird(s) that are Tame Yes	No
Bird(s) that are not Tame	Bird(s) that are not Tame Yes	No
Quakers	Quakers Yes	No
Conures	Conures Yes	No
Finches	Finches Yes	No
Parakeets	Parakeets Yes	No

Is there a particular bird or birds at Gainesville Cockatiel Rescue that you would like to Adopt? If Yes, Please list name(s)

8. If you currently have pets, does your veterinarian:

	Yes	No
See your pets for an annual checkup	If you currently have pets, does your veterinarian: See your pets for an annual checkup Yes	No
See your pets if they are ill	See your pets if they are ill Yes	No
Treat Birds	Treat Birds Yes	No

If you are approved to adopt a bird, are you willing to take the bird(s) to a veterinarian for a well-bird checkup (at your cost) within the first two weeks of receiving him/her/them? NOTE: No bird is offered for adoption who is known to be ill.

9. References: Please list at least 2 people who have known you for at least 5 years. List names, addresses, phone numbers and e-mail addresses.

References: Please list at least 2 people who have known you for at least 5 years. List names, addresses, phone numbers and e-mail addresses.

10. Please check whether you agree or disagree with the following statements:

	Yes	No	N/A
A home visit will be conducted before I will be considered to adopt the bird(s).	Please check whether you agree or disagree with the following statements: A home visit will be conducted before I will be considered to adopt the bird(s). Yes	No	N/A
If I live outside of Gainesville I will pay a gas fee for travel time to my home for the home visit. (exact cost of gas)	If I live outside of Gainesville I will pay a gas fee for travel time to my home for the home visit. (exact cost of gas) Yes	No	N/A
I will not sell/give away or trade my adopted bird but will return it to the rescue immediately if I can no longer care for it.	I will not sell/give away or trade my adopted bird but will return it to the rescue immediately if I can no longer care for it. Yes	No	N/A
I understand that by adopting a bird, I am responsible for caring for the bird, physically, financially and emotionally.	I understand that by adopting a bird, I am responsible for caring for the bird, physically, financially and emotionally. Yes	No	N/A
It is ok for Gainesville Cockatiel Rescue to contact me in the future to check up on the adopted bird(s).	It is ok for Gainesville Cockatiel Rescue to contact me in the future to check up on the adopted bird(s). Yes	No	N/A

Please add any additional comments here:

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