QPSRAPP PLACEMENT QUESTIONNAIRE

PLEASE CAREFULLY READ THE FOLLOWING BEFORE RETURNING THE QUESTIONNAIRE

QPSRAPP is honored to assist you. The filled out Questionnaire or numbered answers should be returned to the QPSRAPP Placement Coordinator at:

QPSRAPP, qpsrapp@yahoo.com

Once the QPSRAPP Placement Coordinator has received the completed Questionnaire, the process of Placement with QPSRAPP has begun. If for any reason the services of QPSRAPP are no longer needed, please contact the Placement Coordinator or the QPSRAPP committee so that we may complete and close our paperwork and alert the volunteers that their assistance is no longer required in this case.

After reviewing the completed Questionnaire, the Placement Coordinator will notify the adopting QPSRAPP volunteers that a Quaker is in need of placement. Interested adopting QPSRAPP volunteers should begin contacting you and it will be your decision to select the volunteer best suited. Feel free to ask any of the volunteers who have contacted you for a copy of their QPSRAPP photo ID and for references. Volunteers have been instructed to carbon copy any communication with you to the QPSRAPP committee, so that the QPSRAPP committee is kept abreast of the status of the placement at all times.

Prior to finalized placement, the adopting volunteer will request of the committee the following forms, which they will bring in hand, on the date and place of transfer:

Adoption Form

Relinquish Form

Two signed copies of each form will be required, for a total of 4 forms.

One copy of the Adoption Form will be sent to the Placement Coordinator, one will remain with the adopting volunteer.

One copy of the Relinquish Form will be sent to the Placement Coordinator, one will remain with you.

Should QPSRAPP be unable to place your Quaker in what you or the QPSRAPP committee feels is a reasonable amount of time, we can then discuss alternative placement among our non-volunteer resources, if desired.

The QPSRAPP committee


RAPP PLACEMENT QUESTIONNAIRE


OWNER INFORMATION

  • Owner Name:_______________________________________
  • Email Address:______________________________
  • Phone Number:_______________________________
  • Adress:_______________________________City________________State_______
  • Zip:_______

  • INFORMATION ON QUAKER TO BE PLACED

  • 1. Bird's Name____________________________
  • 2. Any Previous Names________________________________________
  • 3. Band Number, if One__________________
  • 4. Breeder's Name, if Known_____________________________
  • 5. Approximate Age, If Known________
  • 6. Sex, If Known_________
  • a. By DNA______________
  • b. By Surgery___________
  • 7. Are You the First Owner?_______
  • 8. Time in your possession_________
  • 9. Why Placing the Bird_______________________________________________________________________
  • 10. Number of Previous Owners_____
  • 11. Why Previously Placed____________________________________________________________________
  • 12.Main Diet of Bird:
  • a. Pellets_____
  • b. Brand_______________
  • c. Seeds____
  • d. Veggies & Fruit___
  • 13. Favorite Foods & Snacks___________________________________________
  • 14. Previously in a Breeding Situation____
  • 15. Bird Screams:
  • a. No_____
  • b. Much___
  • c. Some___
  • d. Intervals___
  • 16. Bird Bites:
  • a. Much___
  • b. Some___
  • c. No______
  • 17.If yes, where?
  • a. At cage_____
  • b. At Feed Cups___
  • c. At Perch____
  • d. While Held___
  • 18. Bird Plucks:
  • a. No___
  • b. Some___
  • c. Much______
  • 19. Shows Definite Preference for:
  • a. Women____
  • b. Men______
  • c. Children___
  • 20. Bird Appears Healthy____
  • 21. Any past diseases or medical problems_________________________________
  • 22. On medicines now_________
  • 23. Vet Name & Address__________________________________________________________________
  • 24. Bird's bedtime______
  • 25. Cage covered______
  • 26. Regular Bathing___
  • a. Prefers Baths___
  • b. Misting____
  • c. Showers____
  • 27. Mainly Kept in Cage ___
  • 28. Time out of cage___
  • 29. Any Set Playtime Routine___________________________
  • 30.Exposure to Light:
  • a. Outside Sunshine___
  • b. Sunlight Through Window___
  • c. Full Spectrum Light___
  • d. Standard Room Light___
  • 31.Handled:
  • a. Much____
  • b. Some___
  • c. No______
  • 32. Handled Mainly By:
  • a.Women___
  • b. Men___
  • c. Children___
  • 33. Bonded to Any One Person_____
  • a. Actions Toward Others when with a bonded person_____
  • 34. Other Animals in Home_____
  • a. Bird gets along with them____
  • 35. Any other traits, likes or dislikes of bird____________________________________________
  • 36. Specific Fears:
  • a. Certain Colors____
  • b. Small Children____
  • c. Other Pets_______
  • 37. Upsetting background known about bird___________________________________________________
  • 38. Other Specific Requirements of bird_______________________________________________________________
  • 39. Any Talking, Whistling, Sounds_________________________________________________________________
  • 40. Key Phrases to Bird, such as for bedtime, etc________________________________________________________
  • 41. Items Included with Bird:
  • a. Cage___
  • b. Toys____
  • c. Perch___
  • d. Food____
  • 42. Briefly Describe the Bird's Daily Routine____________________________________________________________________________

  • 43.What do you say to the bird as you go about your daily routine_____________________________________________________________
  • 44. What do you say when it is time for bed_____________________________________________________________________________
  • 45. When time to go to the cage__________________________________________________________________________________
  • 46. When you leave for work, etc__________________________________________________________________________________
  • 47. At bath time__________________________________________________________________________________________________
  • 48. At other important times__________________________________________________________________________________________

  • 49. QPSRAPP will not place any birds in breeding situations unless the relinquishing owner specifically expresses that wish. QPSRAPP also wishes the Relinquishing owner to understand, that the volunteers and committee of QPSRAPP feel that placing a Quaker Parakeet through QPSRAPP in a potential breeding situation defeats the purpose of any placement and rescue program devoted to eliminating the need for placement and therefore, we advise against it. If your desire, as current owner of the Quaker Parakeet to be placed through QPSRAPP, is to have that bird placed in a breeding situation, please give a description as to why:


    50. Any Additional Comments, Information, or Instructions:



    Thank You from QPS-RAPP