Your Details *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Do you own or rent? *

Own

Rent

Other

If renting or other, do you have written permission to keep pets?

Yes

No

Are you over the age of 18 years? *

Yes

No

Do you have access to an avian vet, if required? *

Yes

No

If within reasonable distance, would you be willing for us to visit to see your set up? *

If you choose 'Not within Perth', please answer the following question.

Yes

No

Not within Perth

If you're outside of Perth, would you be willing for us to chat and see your setup via Zoom or other virtual meeting?

Yes

No

Declaration *

By submitting this form, I hereby declare the above information to be correct. I acknowledge that situations can change, and if I were placed with a bird and were 1) faced with the need to rehome; or 2) unable to pay for veterinary care, I would contact Little Beaks before any other action.

I understand and agree