Surrender Agreement 082225 Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Palomacy Pigeon & Dove Adoptions Your Name *FirstLastPrimary Phone *Email *Address of Surrenderer *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeHow Many Birds Are You Surrendering? *Please Indicate Who Is Bird's Owner *I AmA Friend/NeighborFound/StrayBird's Condition and Reason for Surrender *If surrendering more than one bird, provide this information for EACH bird.List Each Bird and Include (If Known) Bird's Name, Type, Sex, and Age *How Long Have You Had the Bird(s)? *If surrendering more than one bird, provide this information for EACH bird.Where Did You Get the Bird(s)? *Store bought? Breeder? Rescue? Found? Hatched? Or...?Bird's Living Situation and History *Please tell us as much of the about the bird(s) as possible: housed outside or indoors, alone or with other bird/animals, diet, preferences, health history, etc.Have You Noticed Any of the Following? *LethargyWatery/unusual droppingsLoss of appetiteWheezing/sneezingParasitesInjuryOther ?Please Tell Us More About What You Have NoticedAny Vet Care or Over the Counter Treatments? *YesNoUnknownIf Yes, What, Where, When and Why?What vet or at-home medical treatment?What Else Should We Know in Order to Provide the Best Care for and Rehome Bird(s)? *Are You Donating Anything with the Bird? (Cage, food, pants, etc.) *YesNoIf Yes, Please List or DescribeBy What Date Must You Transfer the Bird(s)? *Other Comments/InfoPlease Provide Photos of Bird(s) Drag & Drop Files, Choose Files to Upload You can upload up to 10 files. Surrender Agreement It is hereby agreed, by and between Surrenderer and Palomacy Pigeon & 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. Signature * Clear Signature with the Noticed Please Help Us Care for Rescued Birds For every $450 donated, Palomacy can save, on average, the life of one bird. Would you like to make a tax-deductible donation to help offset the cost of rehoming your bird(s)? Your donation can be made online or by mailing a check (made out to Palomacy) to: Palomacy P.O. Box 24585 San Francisco, CA 94124 Custom Captcha * = Submit Form
