Your Details
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First Name
Last Name
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Email
*
Contact Number
*
Are you over the age of 18 years?
*
Name/s
Age (if unknown, how long you have had the bird/s)
*
If this species requires a licence, please add licence number here
If your bird/s have seen a vet (avian or otherwise) in the past, please add their details
Please detail any health issues your bird/s have suffered in the past, or are currently suffering, including any medication
*
Has your bird/s been wormed?
Has your bird/s been treated for mites?
*
Is your bird/s microchipped?
*
What is your bird/s current diet?
*
Please include seed/pellets, any vegies, fruits, and other fresh food. It's important we know everything your bird/s consumes.
What is your bird/s current environment?
*
Indoor cage, limited free flight
Indoor cage, maximum free flight
Outdoor patio cage
Outdoor aviary
Other
If you selected 'Other' above, please add details.
Are you the bird/s first owner?
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If you answered 'No', please provide details (if known) of your bird/s history.
Has your bird/s been around children or other animals (including other species of bird)? Please detail.
*
What is your reason for surrender?
How did you find out about Little Beaks?
Declaration
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By submitting this form, I hereby certify that I am the rightful owner/keeper/caretaker/custodian of the animal(s)
who is/are the subject of this Surrender Form, hereinafter referred to as “the
animal.” I hereby surrender any and all property rights to the animal. I certify that no
other person has a right of property to the animal. I understand that by surrendering my
property rights to the animal, the animal may be transferred into the custody of Little Beaks sanctuary. I understand that once I relinquish the
animal, the animal will not be available to be returned. I further certify that I have read and
understand the terms of this Surrender Form.
