Surrender Questionnaire & Agreement -

Palomacy Pigeon & Dove Adoptions
(a Community Initiatives Project)
www.pigeonrescue.org
Care Coordinator (925) 233-5203
FosterAdopt@pigeonrescue.org
PO Box 24585, San Francisco, CA 94124

(*) indicates a required field

Surrenderer's Information:

First Name: *

Last Name: *

Email address: *

Address *

City *

State *

Zip Code *

Primary Phone: *

Secondary Phone:

How many birds are you surrendering? (Please indicate if the bird is yours or found stray.) *

Please tell us about the bird(s) you are surrendering & the reason.

List each & include, if known, the Bird's Name, Type, Gender, Age: *

By what date must you transfer the bird(s)? *

How long have you had the bird(s)?

Was this bird purchased? If yes, where & when? If not, how did you acquire the bird?

Is this bird an indoor pet, an outside aviary bird or unknown?

Please tell us as much of the bird's living history, condition, diet, preferences, medical history, etc. as you know.

Has the bird ever seen a vet? If yes, please provide reaons, vet's name & contact info.

What else should we know in order to best care for and rehome this bird?

If you are donating the bird's cage or aviary, please describe.

Any other comments/info about the bird:

It is hereby agreed, by and between Surrenderer and Palomacy Pigeon and Dove Adoptions (Palomacy):

1. Surrenderer is no longer able to keep/interested in keeping the bird described above (Bird).

2. Surrenderer knows of no other person who has any claim to the Bird.

3. Surrenderer hereby relinquishes, in favor of Palomacy, all rights, title, and interest to and in this Bird, along with any cage(s), toys, or other items concurrently surrendered. This grant is immediate and absolute.

4. Surrenderer may, at any time prior to the execution of any Bird Adoption Contract between Palomacy and a third party, apply to adopt the Bird, subject to the same conditions and restrictions as any other adoption to a third party.

5. It is the Surrenderer’s understanding that they are not entitled to any portion of any adoption fees or any other donation.

6. It is understood that it is the purpose of this surrender that Palomacy provide for the physical and psychological needs of the Bird, and that the Surrenderer may not, in any way, question or interfere with Palomacy in the care, treatment or placement of the Bird.

7. The surrender of this Bird does not constitute a financial donation, goods, or services to our organization and is, therefore, not tax-deductible.

I HAVE READ AND UNDERSTAND THE ABOVE AND REALIZE THAT IT CONSTITUTES A LEGAL AND BINDING CONTRACT. BY ENTERING MY NAME BELOW, I HAVE AGREED TO AND ACCEPTED THIS CONTRACT.

Palomacy can save, on average, the life of one bird for every $300 donated.

Palomacy is a volunteer-powered, donation-supported nonprofit rescue. We save the lives of birds that would otherwise be killed in shelters or die in the wild for lack of a home.

Would you like to make a tax-deductible donation to help offset the cost of rehoming your bird(s)?

Yes

Your tax-deductible donation can be made online

Please Donate to Help Palomacy Help Birds

Or …
Checks can be made out to:
“CI – Palomacy”
and mailed to:

Palomacy
PO Box 24585
SF, CA 94124

I have read this Contract and agree to be legally bound by its provisions.

Surrenderer's Full Name:

Signature

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Today's Date:

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