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2479 Golden Ave
Letts, IA 52754


Iowa Parrot Rescue and ____________________________________  (hereafter "surrenderer") agree that  the following bird:

_______________________________, a __________________________ is surrendered under the following conditions:

1. Surrenderer states that the bird has no known diseases or disabilities other than


2. Surrenderer states that they are legally in possession of the bird and have the right to place it, and that no other person has any legal or financial claim on the bird.

3. Surrenderer agrees that they have received no promises or inducements from Iowa Parrot Rescue except those included in this agreement.

4. Surrenderer agrees that they are voluntarily surrendering all claim to this bird, and all legal and financial interest in this bird to Iowa Parrot Rescue.

5. Iowa Parrot Rescue agrees that the bird will at no time be sold, traded, or in any other way disposed of for any profit or financial gain; nor will the bird be placed with any person who will use it for commercial breeding purposes; nor will Iowa Parrot Rescue breed any bird, either for personal property or sale.

6.Iowa Parrot Rescue agrees to maintain the bird in healthy and safe conditions, according to generally accepted standards. This shall include such veterinary care as may be necessary.

7. Iowa Parrot Rescue agrees to place the bird only in such home as can provide adequate care, to include housing, diet, and veterinary care, and to exercise due diligence in discovering the suitability of such adoptive home for the bird.

8. Iowa Parrot Rescue and surrenderer agree to mutually release and absolve each other from any and all future claims
____________________________                   ________________________________
Iowa Parrot Rescue                                           Surrenderer


date________________                   phone and email_____________________________