Online Owner Surrender Form

Information about the Duck or Goose
 

How did you acquire this duck/goose?

How long have you owned this duck/goose? years and months

Primary caretaker of this duck/goose: Male    Female

Age of Primary Caretaker:

Under 12   13-20   21-30   31-40   41-60   60+

Duck/goose kept primarily: Indoors    Outdoors

Can this duck/goose fly? Yes    No    Wings Clipped? Yes    No

Please describe the daily diet of this duck/goose:

If this duck/goose is FEMALE, is she currently laying eggs? Yes    No

Have all eggs been normal with a smooth, hard surface? Yes    No

If not, please describe any problems/irregularities:

What kinds of birds were kept with this duck or goose?
 

	Number of Males (List number)	Number of Females (List number)
None
Ducks
Geese
Chickens/Roosters
Turkeys

Why do you want to surrender this duck/goose?

Medical Information

Has this duck/goose ever been seen by a veterinarian? Yes    No

If yes, please complete the following:

Date of last vet visit:

Has this duck/goose ever experienced sudden drastic loss or gain of weight?
Yes    No

If yes, please describe:

Has this duck/goose been wormed within the past three months? Yes    No

If yes, when:

Brand/Type of Wormer Used:

Has this duck/goose ever had a disease or illness? Yes    No

If yes, please provide dates and details:

Has this duck/goose ever taken medication? Yes    No

If yes, please provide dates and details:

Date:	Medication	Vet Prescribed?	Still Taking this Medication?
		Yes    No	Yes    No
		Yes    No	Yes    No
		Yes    No	Yes    No

Has this duck/goose undergone any herbal/alternative medicine or therapy?
Yes    No

If yes, please describe:

Does this duck/goose have any current health problem, injury, or illness that
requires medication and/or specialized care? Yes    No

If yes, please describe:

Please describe below any past health problems, injuries, or illnesses:

Photograph

If you have the capability of sending a digital photo of your pet:

After submitting this Owner Surrender Application to us, immediately email us a clear, sharp and bright photo of the duck or goose you are interested in surrendering. Please do not send us links to view photo albums. Applications that include digital photos are placed higher on the waiting list than those that come without.

In the body of the email please include your full name and the name of the ducks/geese in the photo.

If you do not have the capability of sending a digital photo of your pet:

After submitting this Owner Surrender Application to us, we will email you if we have room at our sanctuary to assist you. If we request a photo of your pet, please write your full name and address on the back of the photo and the name of the duck or goose. Be sure your photo is clear, sharp and bright. Our open slots fill quickly, so please mail your photo immediately upon request to:

Majestic Waterfowl Sanctuary
17 Barker Road
Lebanon, CT 06249

Please include a SASE if you would like your mailed photo returned to you.

Which type of photo will you be sending us? 

Immediately Emailing A Digital Photo  Snail-Mailing A Photo Upon Request

Behavioral Information

Does this duck/goose sometimes bite people or other animals? Yes    No

Is this duck/goose imprinted on humans? Yes    No

Please check the personality characteristics that best describe this duck/goose:

	Lap Bird: This duck or goose will walk up to greet their caretaker and loves to be petted and picked up.
	Welcoming: This duck or goose will walk up to greet their caretaker to be petted, but prefers not to be picked up.
	Friendly: This duck or goose will not approach their caretaker, but their caretaker can approach the animal and freely pet them. The animal prefers not to be picked up.
	Shy: This duck or goose will not approach their caretaker, but their caretaker can come within three feet of the animal. The animal will sometimes allow limited petting.
	Timid: This duck or goose will run approximately between five and ten feet away from their caretaker before stopping. They will rejoin the flock once the caretaker has backed away.
	Nervous: This duck or goose will run from their caretaker and keep on running. The animal is fearful of humans to the point of risk of self-injury or escape.
	Aggressive: This duck or goose will chase and attempt to bite their caretaker.

Please list anything else you think we should know about this duck/goose:

Please describe the daily routine of this duck/goose:

Acknowlegement

By submitting this form, I certify that the information provided within is true and accurate. I understand that Majestic Waterfowl Sanctuary retains the right to decline the acceptance of this application, and I further understand that they are in no way obligated to provide me with an explanation for my duck or goose not being accepted into their rescue program. I also understand that in most cases a minimum donation of $100 per bird is required to help defray Majestic's expenses.

Select One I have read and agree to the above statement.

Release of Veterinarian Records

Select One Yes I authorize the release of records from vet. No I do not authorize the release of records from vet.