Surrender Request

You may use this on-line form if you wish to make application to surrender your bird(s) to Parrots-R-4Ever Avian Rescue & Sanctuary. All information submitted as part of this application will be treated as confidential and we will contact only you or your designated alternate. Required lines are marked with an * symbol. We can not respond to your request without this minimum information. Please fill in the form as completely and accurately as possible, then click the "Submit" button at the bottom of the form.
Your Name: *
Alternate Contact Name:
Street Address:
City:
State:
Zip Code:

Phone - Daytime: *
Phone - Evenings & Weekends: *
Email Address: *
Best Days & Times To Call You:
Bird(s) Name(s): *
Bird(s) Species: *
Bird(s) Age (approx. ok):
Bird(s) Gender (if known):
Reason you must give up your bird(s):*