Exotic Bird Intake Agreement
This form is confidential after intake
Date: (day)_________, (month)____________, (year)___________.
It is agreed that (name of owner)____________________________________________________,
of ___________,
city)_____________________________,(province)____________________________,(postal code)_____________________,
(phone#)____________________. Transfers complete ownership, responsibilities
and duties of (# of bird(s)) _________, (breed of
bird(s))__________________________________,
(name of bird(s)) _______________________________________________________________,
(age
of bird(s))__________________________(band #(s))________________________________________,
to Earth Stop One. It is agreed that Earth Stop One
will give the above bird or birds a lifelong home.
It is also agreed that Earth Stop One will not commercial breed, or sell the above mentioned bird or birds. The
previous owner with notice will have the right to visit the (bird(s)). The previous owner is also transferring to Earth
Stop One the items and info below :
1. Cage(s), yes____, no____
2. DNA paper(s) yes____, no____, (sex(s)) male____, female____
3. Toys yes____, no____
4. Food yes____, no____
5. Medicine yes____, no____, if yes what kind and instructions __________________________________________
6. Carrying cage(s) yes____, no____
7. Medical History yes _____, no _____
8. Name of Vet________________Address______________________________Phone#________________
Other instructions or comments:____________________________________________________________________
_____________________________________________________________________________________________
Signatures:
Earth Stop One representative: _______________________________
Owner:___________________________, Witness:___________________________