Beak n Wings, Inc.

Educational Pet Bird Club & Rescue

501(c)3 Non-Profit organization

EIN: 77-0630832

Small Bird Adoption Application

9010-B Rosehill Rd., Ste B.     │   Lenexa, KS 66215      │  T-913-322-3398      │    adopt.bnw@gmail.com    │       www.beaknwings.org

Bird care is a serious responsibility. Beak n Wings’ policy is to insure that each person adopting a bird can provide suitable housing, is morally and financially capable of providing for the bird, and is educated in proper care and nutrition for the bird. You must be at least 18 years of age to adopt a bird from Beak n Wings. This application is designed to provide Beak n Wings with necessary information to begin an adoption placement. Please answer all questions and return to the above address. A representative of Beak n Wings will contact you and a home visit may be scheduled. If any questions are left unanswered, your application will not be processed.

NOTE: This application is for smaller birds ONLY (Canaries, Finch, Love Bird, Parakeets, Cockatiels, and Doves). If this form is used for any other bird, your application for adoption will NOT be considered.

Contact Information

Age Information

Employment

All information in this application is for the exclusive use of Beak n Wings, Inc.,

and will not be sold or given to any other organization.

Housing

Health

Smoking

Animals:

Veterinarian Information

Bird interests & Experience

Agreement

I understand the bird (s) must remain in my home. If circumstances were to change I understand I must contact Beak n Wings, Inc, right away. Change of address and phone numbers are to be forwarded to Beak n Wings ASAP  

A Beak n Wings representative may make periodic home visits. I also understand references may be contacted prior to approval of this application.

I, the undersigned, acknowledge there are risks in visiting and / or handling exotic birds, including illness or injury to pets or myself and/or damage to my personal property.  

I agree to release Beak n Wings, Inc., from any liability in the event of illness, injury or property damage occurs as result of my visits and /or exposure to Beak n Wings, Inc., foster or adopted birds. 

I acknowledge that in such activities as dealing with animals, using equipment, driving vehicles and so forth, it is the sole

responsibility of me to exercise caution and good judgment to avoid injury. 

I authorize Beak n Wings, Inc to confer with my avian vet regarding the health and care of my current bird (s) / animals in my home.

By my digital signature, I hereby certify that the information I have provided on this adoption application is true to the best of my

knowledge.  

I have read this release and understand its terms. I acknowledge that this release is legally binding.

All information in this application is for the exclusive use of Beak n Wings, Inc.,

And NOT sold or given to any other organization.

Beak n Wings, Inc

Release, Waiver & Indemnity

for

Visitors & Volunteers

I, voluntarily and knowingly sign this Release, Waiver & Indemnity (“Waiver”) with the express intention of divesting Beak n Wings, Inc, a Kansas non-profit, from any liabilities and obligations as described below. I understand that any animal can inflict injuries and that the birds at Beak n Wings are birds that have been rescued or given up by their owners, are unpredictable, and may bite or scratch me for any reason or for no reason. I assume all risk associated with Beak n Wings and with viewing, handling, feeding and caring for the birds at Beak n Wings.

I hereby release and forever discharge Beak n Wings and its employees, volunteers, directors, officers, administrators, agents, and assigns (collectively, “Indemnitee”) from all liability for any and all claims, demands, actions, causes of action or suits of any kind or nature whatsoever and particularly on account of any injuries (e.g., including, but not limited to, bird bites), both to person and property, and economic and non-economic losses I may suffer, that may result from, or develop in the future as a result of my handling, viewing, holding, petting, observing or otherwise the birds at or in the possession or control of Beak n Wings, Inc.  I further agree that if, despite this Waiver, I or anyone on my behalf makes a claim against Beak n Wings or any Indemnitee, I will indemnify, save and hold harmless Beak n Wings or any Indemnitee from any damages, losses and expenses including, but not limited to, legal fees, courts costs, and litigation expenses.

In exchange for granting this Waiver, I acknowledge that I will be allowed access to the birds at Beak n Wings.

I understand that the following are some, but not all, of the risks associated with being handling birds from Beak n Wings and all birds:

• Bites or scratches from the birds

• Slips, trips and falls resulting from wet or slippery floors

• Hitting head on objects such as cages, perches, cabinets, etc. or other Injuries resulting from cages, perches, cabinets, etc.

• Zoonotic illnesses (human illness contracted from animals)

• Injuries related to lifting animals, food, cages or equipment

• Damage to clothing from animals, cages, chemicals, etc.

I agree to use reasonable care at all times while I am around the birds of Beak n Wings. I agree to follow all rules established by Beak n Wings and have read, understand and agree to the Beak n Wings Rules provided to me concurrently with this Waiver.

I acknowledge and agree that I: (a) fully understand the meaning of this Waiver and recognize my right to seek the advice of an attorney before signing it; (b) have signed it freely and without any inducement or assurance of any nature; (c) intend it to be a complete unconditional release of liability to the greatest extent allowed by law; and (d) agree that, if any portion of this agreement is held to be

invalid, the balance notwithstanding shall continue in full force and effect. The acceptance of this waiver shall not operate as an admission of liability on the part of anyone, nor as a waiver or bar with respect to any claim that Beak n Wings may have against the undersigned.

This release is binding on my heirs, executors, assigns and administrators. The undersigned is aware of the risks of visiting or handling the birds at Beak n Wings and hereby assumes all risks. The risks include those foreseen and unforeseen, known and unknown.

I have read this Waiver carefully and fully understand its content, and voluntarily agree to its terms. I acknowledge that, in signing this Waiver, I am waiving certain legal rights, including the right to sue.

BEAK N WINGS, INC. PHOTO RELEASE FORM

I hereby grant Beak n Wings, Inc. permission to use my likeness in a photograph, video, or other digital media (“photo”) in any and all of its publications, including web-based publications, without payment or other consideration.

I understand and agree that all photos will become the property of Beak n Wings, Inc. and will not be returned.

I hereby irrevocably authorize Beak n Wings, Inc. to edit, alter, copy, exhibit, publish, or distribute these photos for any lawful purpose. In addition, I waive any right to inspect or approve the finished product wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photo.

I hereby hold harmless, release, and forever discharge Beak n Wings, Inc. from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.

I HAVE READ AND UNDERSTAND THE ABOVE PHOTO RELEASE. I AFFIRM THAT I AM AT LEAST 18 YEARS OF AGE, OR, IF I AM UNDER 18 YEARS OF AGE, I HAVE OBTAINED THE REQUIRED CONSENT OF MY PARENTS/GUARDIANS AS EVIDENCED BY THEIR SIGNATURES BELOW. I ACCEPT:

Our MINIMUM cage requirements:

Parakeets, Cockatiels, Lovebirds, Quakers: 27”w x 24”d

Ringnecks, Conures, Pionus, Lories, Meyers, Senegals: 32”w X 23”d

African Greys, Small Cockatoos, Eclectus, Amazons, Small Macaws: 36”w x 28”d

Larger Cockatoos and  smaller Macaws: 48”w x 36”d

We recommend 64”w x 32”d or 80”w x 40”d cages for the larger birds (Moluccans and Greenwing Macaws).

Make sure bar spacing is appropriate for your bird.

For office use only:

DO NOT WRITE IN BELOW SECTION:

Applicant, please make copies of  the complete application include this page when you submit your application

Approved                                                                                              Declined  

If declined explain why: ________________________________________________________

___________________________________________________________________

___________________________________________________________________

__________________________________________________________________

Approved for Adoption List Birds:

Bird Name _______________ Species _______________ Date _____________

Bird Name _______________ Species _______________ Date _____________

Bird Name _______________ Species _______________ Date ____________

Bird Name ________________ Species _______________ Date ____________

Signature                                                                Print

VP R/A or ED only                                                VP R/A or ED only

Date of Home Study ____________________________

NOTE: The surveyor does NOT have the authority to approve or decline an applicant looking to foster. The decision shall be that of the Vice President of Rescue / Adoption or the Executive Director