Relinquishment Form

Adopt a Bird Application

*Bird's Name

Species

Band Number

Age

Sex

Owner's Name

Address

City

State

Zip Code

Phone Number

Secondary Phone Number

*Email

Secondary Email

*Avian Vet's Name

*Avian Vet's Contact Info

*Last Vet Visit Date

*I hereby authorize the release of all medical records pertaining to the above released bird to representatives of Our Little Flock RescueFull Legal Name here

*Please list any known health problems or injuries:

*Please list any known history or important information:

Do you hereby donate to Our Little Flock Rescue the above listed bird to be placed in OLFR’s Adoption Program. I relinquish all claims to the above listed bird. Check YES or NO.

YES NO

*By typing your full name below you are agreeing that it is your electronic signature.Type Full Legal Name Here.

*DateInput today's date MM/DD/YYYY

Fields with (*) are compulsory.

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Relinquishment Form

Adopt a Bird Application