Avian Adoption Application Not every bird will fit into your lifestyle. Our adoption counselors will ask many questions to determine which bird will do well in your home. This way we can be sure the bird you get will be the bird you want, to love for its lifetime! Please, understand that we deal with homeless or unwanted animals. Many of our animals come from unknown backgrounds through the local shelters Most have medical or behavioral concerns that we have addressed as well as providing their well care. We were truly their last chance. The adoption process may seem time consuming, but we wish to maximize an animal's chance for a successful, permanent adoption. Adopting a companion pet is a major consideration and responsible pet ownership demands a considerable commitment. All we ask in return is that you love and care for this pet for its lifetime and make a donation that will allow us to help the next “friend” in need. Thank you for your interest in our animals.Birds name you are interested in adopting* Intended DonationMinimum Donations are from $50-$400 per bird depending on the speciesYour Contact InformationName* First Last Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home Phone*Cell PhoneWork PhoneEmail* How long have you lived at the above address?* Less than 3 years 3 years or more If less than 3 years, please list your previous address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code What type is your residence?* House Condominium Apartment Other Do your own or rent your current home?* Own Rent If renting, does your landlord allow pets?* yes no Landlord’s Name First Last Landlord’s Phone Number*A statement from the landlord, with address, and phone number is required.) Please call you landlord and have it faxed to (760)433-3138 or e-mailed to Info@LastChanceAtLife.orgHousehold InformationYour Age* First 18-25 26-45 46-65 66+ Do you have children living (full or part-time) in your home?* yes no If yes, please list names and ages below*NameAge Click on the "+" button to add additional childrenWho will be the primary caregiver(s) for this bird?* Are all parties in the household aware that this adoption application is being made?* yes no Does anyone in your household have a health condition(s) that could restrict his/her ability to handle/care for a bird?* yes no If yes, please describeDoes anyone in your home have allergies?* yes no If yes, please list the allergies below Click on the "+" button to add additional allergiesDoes anyone in your home smoke?* yes no Do you currently have pets ( birds or otherwise) living in your home?* yes no If yes, please list species and how many:*specieshow many Click on the "+" button to add additional speciesHave you previously owned birds that you no longer own?* yes no If yes, why do you no longer have these birds? What happened to them?*Do you currently have an avian veterinarian? yes no Clinic Name* Avian Vet’s Name First Last Clinic Phone Number*Clinic Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code If no, do you need a list of avian veterinarians in your area?* yes no Do you need instruction and/or information regarding proper bird care and quarantine protocol?* yes no Anticipated Household ChangesIf your living and/or financial situation were to change dramatically, would you be able to keep a bird?* yes no Please describe the lifestyle changes you might anticipate over the next 5 years? 10 years? 25 years?*When you travel or go on an extended vacation, who will care for your bird?*What provisions have you made for your birds and/or other pets in the event of your illness or death?*Bird Interests & ExperienceHow did you learn about LCAL?* What experience do you have with captive birds?*What is the most important characteristic you are looking for in a bird?* What species of bird are you interested in adopting and why?*I understand this bird must remain in my home. If my circumstances change, I understand I must contact LCAL to return the bird and will not rehome the bird myself* Yes, I understand. Signature Reset signature Signature locked. Reset to sign again Would you like to be added to our mailing list?* Yes, please. No, thank you. PhoneThis field is for validation purposes and should be left unchanged.
