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Center
for Avian Rehabilitation & Education, Inc.
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Release/Surrender Agreement
Name:________________________________________
Phone No.____________________
Address:___________________________________________________________________
City, State, Zip:_____________________________________________________________
This Agreement is entered into by the undersigned Pet Owner, or a Designated Representative of the Pet Owner (hereinafter referred to as "Owner"), and the Center for Avian Rehabilitation & Education Inc. (hereinafter referred to as “C.A.R.E.).
1. Owner agrees to fully release the above-mentioned bird(s) to C.A.R.E. and acknowledges that he/she is fully relinquishing any further rights to the above-mentioned bird(s).
2. Owner understands that C.A.R.E. will do all in its power to maintain the birds in the best manner possible; however, if the birds are found to be terminally ill, or, in the discretion of C.A.R.E., to be a danger to humans, or to be mentally unfit to the point of being a danger to themselves, euthanasia is an option.
3. Owner acknowledges that he/she has fully and completely disclosed any potentially dangerous behavior(s) to C.A.R.E.
4. Owner acknowledges that he/she has fully and completely disclosed any contagious diseases, including diseases contagious to birds, other pets, or to humans, to C.A.R.E.
Owner certifies that the information given above is true and correct and Owner agrees that any misrepresentation of facts may result in a penalty of $1,000 per violation of each section of this Release Agreement and for any misstatement on this Agreement that led to the release.
*We require an appropriately sized cage, in good condition, for each bird surrendered. If you do not have an appropriate cage, we require a cash donation to help offset our cost of purchasing one.
Dated:______________________ Signed:________________________________________
Owner or Designated Representative
Dated:______________________
Signed:________________________________________
Center for Avian Rehabilitation & Education Inc.
PROFILE OF RELEASED BIRD
Name of Bird:____________________ Species:_____________________________
Age:_______________________ Gender:______________________________
How long have you owned:___________ Where did you get the bird:_________________
Name of Veterinarian:______________ Reason for release:________________________
Describe this bird:
Active
Playful
Shy/Quiet
Affectionate
Wild
Destructive
Friendly
Hand-Tame
A Biter
Other: _______________________________________________
Does the bird have any fears: _______ If yes, what are they?__________________________
How much time did the bird spend out of his/her cage on a daily basis?_____________________
How is the bird with children?________________ Ages of children exposed to:___________
What other types of pets has the bird been exposed to?_____________________________
What does the bird eat?_______________________________________________________
Does the bird have any medical problems? If yes, please describe:_____________________
__________________________________________________________________________
Is there any other information you’d like us to know?_________________________________
__________________________________________________________________________
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