Bequest – Lifelong Care Form

For your peace of mind, please fill in this Lifelong Care form, to capture your birds’ likes, dislikes and needs. We will keep it safely on file, for such time when it is needed by us. Please do not hesitate to call with questions or assistance in completing this form.

Please remember to keep all documentation such as receipts, breeder certificates, cites documentation, vet reports etc. in a safe place, so that we can collect them when you hand over the bird. Thank you

Please note this form is not to be used for Safehouse bird evaluations. If you have a safehouse bird, please go to the member’s area of the website where the Safehouse bird evaluation forms are located.

Birdline Reference Number *

Please enter here the reference number given to you by the helpteam. Without this reference number we are unable to accept your bird. The reference number will be prefixed with the letter B. If you have a safehouse bird, please use the safehouse evaluation form in the members' area of the website.

Donor Details

Name *

First

Last

Phone *

Phone

Email *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

How many birds are you handing over to Birdline *1234 56

If you have multiple indoor or aviary birds, please input the number of different species, rather than the total number of birds.

Veterinary Information

If your bird has been seen by a veterinarian, please asks for its complete medical records and forward them with this form.

Have the bird(s) ever been seen by a vet? *YesNoDon't know

Vet’s Name

Clinic Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Phone

Website / URL

Bird Information

If you are handing in multiple indoor or aviary birds, please use Bird 1 to tell us about all the birds of a specific species. E.g. tell us about all of your cockatiels in Bird 1 section, all your budiges in Bird 2 section and so on.

Bird 1 - Name *

Bird 1 - Species *

Bird 1 - Age / Hatch Date *

Bird 1 - Gender *

• Female
• Male
• Unknown

Bird 1 - How and where was the gender verified?

Bird 1 - Does the bird have a leg ring *

• Yes
• No

Bird 1 - Which legLeftRight

Bird 1 - Colour of leg ring

Bird 1 - Leg Ring ID Number

Bird 1 - Microchip ID Number (if available)

Bird 1 - When and where did you acquire the bird? *

Bird 1 - Does the bird come with any of the following items (select all relevant) *

• Main Cage
• Travel Cage
• Playstand
• Toys and Perches
• Food
• None

Bird 1 - Please describe the equipment and its condition in detail *

Bird 1 - Please describe your bird’s overall health / physical condition *

Bird 1 - Please detail any injuries your bird has sustained *

Bird 1 - Does your bird have any medical/physical condition that requires treatment ? *

Bird 1 - Please list any vet visits and treatments received to-date *

Bird 1 - Please list the foods your bird currently eats, including specific food names and brands where applicable, please highlight any favourite foods. *

Bird 1 - Please list any vitamin supplements that you give your bird and how you administer them. *

Bird 1 - Who is your bird’s primary care giver? *

Bird 1 - Is your bird tame ? *

• Yes
• No
• Somewhat

Bird 1 - Do you or any of your family handle the bird ? Please give details *

Bird 1 - Does your bird particularly like or dislike any member/s of your household? Please give details. *

Bird 1 - Please describe how your bird reacts around children *

Bird 1 - Does your bird currently (or in the past) live with other birds. If yes, how does it react to them? *

Bird 1 - How does your bird react to any other pets in your household? *

Bird 1 - Is your bird destructive? *

Bird 1 - Does your bird have any known behavioural problems? Screaming, plucking, chewing, biting, etc) *

Please give detail and outline any possible reasons that may cause this.

Bird 1 - Describe your bird’s playtime activities and any favourite toys. *

Bird 1 - Describe your bird’s bathing habits, including frequency, likes, and dislikes. *

Bird 1 - Describe your bird’s sleeping habits (including bedtime, wake-up time, nap times, and hours of sleep each day. *

Bird 1 - Does your bird ever have night frights? If yes, please give details *

Bird 1 - Do you cover your bird's cage. If yes when? *

Bird 1 - How many hours a day does your bird spend outside the cage? *

Bird 1 - How many hours a day does your bird spend home alone? *

Bird 1 - Do you leave the radio, TV, or other audio/video on for your bird? *

Bird 1 - Please give any other relevant information to help us care for your bird in the future and to make it as happy as possible in its new foster home. *

Bird 2 - Name *

Bird 2 - Species *

Bird 2 - Age / Hatch Date *

Bird 2 - Gender *

• Female
• Male
• Unknown
• Both / multiple birds

Bird 2 - How and where was the gender verified? *

Bird 2 - Does the bird have a leg ring *

• Yes
• No

Bird 2 - Which legLeftRight

Bird 2 - Leg ring colour

Bird 2 - Leg ring ID Number

Bird 2 - Microchip ID Number (if available)

Bird 2 - When and where did you acquire the bird? *

Bird 2 - Does the bird come with any of the following items (select all relevant *

• Main Cage
• Travel Cage
• Playstand
• Toys and Perches
• Food
• None

Bird 2 - Please describe the equipment and its condition in detail *

Bird 2 - Please describe your bird’s overall health / physical condition *

Bird 2 - Please detail any injuries your bird has sustained *

Bird 2 - Does your bird have any medical/physical condition that requires treatment ? *

Bird 2 - Please list any vet visits and treatments received to-date *

Bird 2 - Please list the foods your bird currently eats, including specific food names and brands where applicable, please highlight any favourite foods. *

Bird 2 - Please list any vitamin supplements that you give your bird and how you administer them. *

Bird 2 - Who is your bird’s primary care giver? *

Bird 2 - Is your bird tame *

• Yes
• No
• Somewhat

Bird 2 - Do you or any of your family handle the bird ? Please give details *

Bird 2 - Does your bird particularly like or dislike any member/s of your household? Please give details. *

Bird 2 - Please describe how your bird reacts around children *

Bird 2 - Does your bird currently (or in the past) live with other birds. If yes, how does it react to them? *

Bird 2 - How does your bird react to any other pets in your household? *

Bird 2 - Is your bird destructive? *

Bird 2 - Does your bird have any known behavioral problems such as screaming, plucking, chewing, biting? *

Please give detail and outline any possible reasons that may cause this.

Bird 2 - Describe your bird’s playtime activities and any favourite toys. *

Bird 2 - Describe your bird’s sleeping habits (including bedtime, wake-up time, nap times, and hours of sleep each day *

Bird 2 - Describe your bird’s bathing habits, including frequency, likes, and dislikes. *

Bird 2 - Does your bird ever have night frights? If yes, please give details. *

Bird 2 - Do you cover your bird's cage. If yes when? *

Bird 2 - How many hours a day does your bird spend outside the cage? *

Bird 2 - How many hours a day does your bird spend home alone? *

Bird 2 - Do you leave the radio, TV, or other audio/video on for your bird? *

Bird 2 - Please give any other relevant information to help us care for your bird in the future and to make it as happy as possible in its new foster home. *

Bird 3 - Name *

Bird 3 - Species *

Bird 3 - Age / Hatch Date *

Bird 3 - Gender *

• Female
• Male
• Unknown
• Both / multiple birds

Bird 3 - How and where was the gender verified? *

Bird 3 - Does the bird have a leg ring *

• Yes
• No

Bird 3 - Which legLeftRight

Bird 3 - Leg ring colour

Bird 3 - Leg ring ID Number

Bird 3 - Microchip ID Number (if available)

Bird 3 - When and where did you acquire the bird? *

Bird 3 - Does the bird come with any of the following items (select all relevant) *

• Main Cage
• Travel Cage
• Playstand
• Toys and Perches
• Food
• None

Bird 3 - Please describe the equipment and its condition in detail *

Bird 3 - Please describe your bird’s overall health / physical condition *

Bird 3 - Please detail any injuries your bird has sustained *

Bird 3 - Does your bird have any medical/physical condition that requires treatment ? *

Bird 3 - Please list any vet visits and treatments received to-date *

Bird 3 - Please list the foods your bird currently eats, including specific food names and brands where applicable, please highlight any favourite foods. *

Bird 3 - Please list any vitamin supplements that you give your bird and how you administer them. *

Bird 3 - Who is your bird’s primary care giver? *

Bird 3 - Is your bird tame ? *

• Yes
• No
• Somewhat

Bird 3 - Do you or any of your family handle the bird ? Please give details *

Bird 3- Does your bird particularly like or dislike any member/s of your household? Please give details. *

Bird 3 - Please describe how your bird reacts around children. *

Bird 3 - Does your bird currently (or in the past) live with other birds. If yes, how does it react to them? *

Bird 3 - How does your bird react to any other pets in your household? *

Bird 3 - Is your bird destructive? *

Bird 3 - Does your bird have any known behavioral problems such as screaming, plucking, chewing, biting? *

Please give detail and outline any possible reasons that may cause this.

Bird 3 - Describe your bird’s playtime activities and any favourite toys. *

Bird 3 - Describe your bird’s bathing habits, including frequency, likes, and dislikes. *

Bird 3 - Describe your bird’s sleeping habits (including bedtime, wake-up time, nap times, and hours of sleep each day *

Bird 3 - Does your bird ever have night frights? If yes, please give details. *

Bird 3 - Do you cover your bird's cage. If yes when? *

Bird 3 - How many hours a day does your bird spend outside the cage? *

Bird 3 - How many hours a day does your bird spend home alone? *

Bird 3 - Do you leave the radio, TV, or other audio/video on for your bird? *

Bird 3 - Please give any other relevant information to help us care for your bird in the future and to make it as happy as possible in its new foster home. *

Bird 4 - Name *

Bird 4 - Species *

Bird 4 - Age / Hatch Date *

Bird 4 - Gender *

• Female
• Male
• Unknown
• Both / multiple birds

Bird 4 - How and where was the gender verified? *

Bird 4 - Does the bird have a leg ring *

• Yes
• No

Bird 4 - Which legLeftRight

Bird 4 - Leg ring colour

Bird 4 - Leg ring ID Number

Bird 4 - Microchip ID Number (if available)

Bird 4 - When and where did you acquire the bird? *

Bird 4 - Does the bird come with any of the following items (select all relevant) *

• Main Cage
• Travel Cage
• Playstand
• Toys and Perches
• Food
• None

Bird 4 - Please describe the equipment and its condition in detail *

Bird 4 - Please describe your bird’s overall health / physical condition *

Bird 4 - Please detail any injuries your bird has sustained *

Bird 4 - Does your bird have any medical/physical condition that requires treatment ? *

Bird 4 - Please list any vet visits and treatments received to-date. *

Bird 4 - Please list the foods your bird currently eats, including specific food names and brands where applicable, please highlight any favourite foods. *

Bird 4 - Please list any vitamin supplements that you give your bird and how you administer them. *

Bird 4 - Who is your bird’s primary care giver? *

Bird 4 - Do you or any of your family handle the bird ? Please give details. *

Bird 4 - Is your bird tame ? *

• Yes
• No
• Somewhat

Bird 4- Does your bird particularly like or dislike any member/s of your household? Please give details. *

Bird 4 - Please describe how your bird reacts around children. *

Bird 4 - Does your bird currently (or in the past) live with other birds. If yes, how does it react to them? *

Bird 4 - How does your bird react to any other pets in your household? *

Bird 4 - Is your bird destructive? *

Bird 4 - Does your bird have any known behavioral problems such as screaming, plucking, chewing, biting? *

Please give detail and outline any possible reasons that may cause this.

Bird 4 - Describe your bird’s playtime activities and any favourite toys. *

Bird 4 - Describe your bird’s bathing habits, including frequency, likes, and dislikes. *

Bird 4 - Describe your bird’s sleeping habits (including bedtime, wake-up time, nap times, and hours of sleep each day. *

Bird 4 - Does your bird ever have night frights? If yes, please give details. *

Bird 4 - Do you cover your bird's cage. If yes when? *

Bird 4 - How many hours a day does your bird spend outside the cage? *

Bird 4 - How many hours a day does your bird spend home alone? *

Bird 4 - Do you leave the radio, TV, or other audio/video on for your bird? *

Bird 4 - Please give any other relevant information to help us care for your bird in the future and to make it as happy as possible in its new foster home. *

Bird 5 - Name *

Bird 5 - Species *

Bird 5 - Age / Hatch Date *

Bird 5 - Gender *

• Female
• Male
• Unknown
• Both / multiple birds

Bird 5 - How and where was the gender verified? *

Bird 6 - How and where was the gender verified? *

Bird 5 - Does the bird have a leg ring *

• Yes
• No

Bird 5 - Which legLeftRight

Bird 5 - Leg ring colour

Bird 5 - Leg ring ID Number

Bird 5 - Microchip ID Number (if available)

Bird 5 - When and where did you acquire the bird? *

Bird 5 - Does the bird come with any of the following items (select all relevant) *

• Main Cage
• Travel Cage
• Playstand
• Toys and Perches
• Food
• None

Bird 5 - Please describe the equipment and its condition in detail *

Bird 5 - Please describe your bird’s overall health / physical condition *

Bird 5 - Please detail any injuries your bird has sustained *

Bird 5 - Does your bird have any medical/physical condition that requires treatment ? *

Bird 5 - Please list any vet visits and treatments received to-date. *

Bird 5 - Please list the foods your bird currently eats, including specific food names and brands where applicable, please highlight any favourite foods. *

Bird 5 - Please list any vitamin supplements that you give your bird and how you administer them. *

Bird 5 - Who is your bird’s primary care giver? *

Bird 5 - Is your bird tame ? *

• Yes
• No
• Somewhat

Bird 5 - Do you or any of your family handle the bird ? Please give details. *

Bird 5 - Does your bird particularly like or dislike any member/s of your household? Please give details. *

Bird 5 - Please describe how your bird reacts around children. *

Bird 5 - Does your bird currently (or in the past) live with other birds. If yes, how does it react to them? *

Bird 5 - How does your bird react to any other pets in your household? *

Bird 5 - Is your bird destructive? *

Bird 5 - Does your bird have any known behavioral problems such as screaming, plucking, chewing, biting? *

Please give detail and outline any possible reasons that may cause this.

Bird 5 - Describe your bird’s playtime activities and any favourite toys. *

Bird 5 - Describe your bird’s bathing habits, including frequency, likes, and dislikes. *

Bird 5 - Describe your bird’s sleeping habits (including bedtime, wake-up time, nap times, and hours of sleep each day. *

Bird 5 - Does your bird ever have night frights? If yes, please give details. *

Bird 5 - Do you cover your bird's cage. If yes when? *

Bird 5 - How many hours a day does your bird spend outside the cage? *

Bird 5 - How many hours a day does your bird spend home alone? *

Bird 5 - Do you leave the radio, TV, or other audio/video on for your bird? *

Bird 5 - Please give any other relevant information to help us care for your bird in the future and to make it as happy as possible in its new foster home. *

Bird 6 - Name *

Bird 6 - Species *

Bird 6 - Age / Hatch Date *

Bird 6 - Gender *

• Female
• Male
• Unknown
• Both / multiple birds

Bird 6 - How and where was the gender verified? *

Bird 6 - Does the bird have a leg ring *

• Yes
• No

Bird 6 - Which legLeftRight

Bird 6 - Leg ring colour

Bird 6 - Leg ring ID Number

Bird 6 - Microchip ID Number (if available)

Bird 6 - When and where did you acquire the bird? *

Bird 6 - Does the bird come with any of the following items (select all relevant) *

• Main Cage
• Travel Cage
• Playstand
• Toys and Perches
• Food
• None

Bird 6 - Please describe the equipment and its condition in detail *

Bird 6 - Please describe your bird’s overall health / physical condition *

Bird 6 - Please detail any injuries your bird has sustained *

Bird 6 - Does your bird have any medical/physical condition that requires treatment ? *

Bird 6 - Please list any vet visits and treatments received to-date. *

Bird 6- Please list the foods your bird currently eats, including specific food names and brands where applicable, please highlight any favourite foods. *

Bird 6 - Please list any vitamin supplements that you give your bird and how you administer them. *

Bird 6 - Is your bird tame ? *

• Yes
• No
• Somewhat

Bird 6 - Who is your bird’s primary care giver? *

Bird 6 - Do you or any of your family handle the bird ? Please give details. *

Bird 6 - Does your bird particularly like or dislike any member/s of your household? Please give details. *

Bird 6 - Please describe how your bird reacts around children. *

Bird 6 - Does your bird currently (or in the past) live with other birds. If yes, how does it react to them? *

Bird 6 - How does your bird react to any other pets in your household? *

Bird 6 - Is your bird destructive? *

Bird 6 - Does your bird have any known behavioral problems such as screaming, plucking, chewing, biting? *

Please give detail and outline any possible reasons that may cause this.

Bird 6 - Describe your bird’s playtime activities and any favourite toys. *

Bird 6 - Describe your bird’s bathing habits, including frequency, likes, and dislikes. *

Bird 6 - Describe your bird’s sleeping habits (including bedtime, wake-up time, nap times, and hours of sleep each day. *

Bird 6 - Does your bird ever have night frights? If yes, please give details. *

Bird 6 - Do you cover your bird's cage. If yes when? *

Bird 6 - How many hours a day does your bird spend outside the cage? *

Bird 6 - How many hours a day does your bird spend home alone? *

Bird 6 - Do you leave the radio, TV, or other audio/video on for your bird? *

Bird 6 - Please give any other relevant information to help us care for your bird in the future and to make it as happy as possible in its new foster home. *

File Upload

Please upload any images, certificates, or documentation which you think will be helpful. These may include layout of cage perches and toys, pictures of the bird, injuries etc.

File Upload

Click or drag files to this area to upload. You can upload up to 20 files.

Please upload one or more good quality / clear images of the bird(s), preferably without cage bars obscuring them. Please also attach photos of any equipment the bird(s) comes with.

Comments

Where did you learn about Birdline?

We welcome your feedback regarding the services we provide and would appreciate your comments.

Confirmation

Please type your name below to confirm that the information provided is accurate to the best of your knowledge.

Name *

First

Last

Name

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