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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:___________________________