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Chick Adoption Form

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Name:*
E-mail:*
Address:*
Phone:*
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Do you own, rent, or lease?:*
I am legally zoned to house*
Provide Landlord Name & Contact Phone
I am (note: we adopt to qualified homes, regardless of diet)*
My interest in adopting (check all that apply)*
Do you currently have chickens?:*
How many chickens do you have?
What is the longest you have had a chicken live?
Age of your oldest chicken?
Have you taken your chicken to a veterinarian for treatment, if needed?
Have you had chickens in the past?
What is the longest you have had a chicken live to be?
What other domestic species live on your property (check all that apply):*
I am interested in adopting (check all that applies)*
How many hens?*
How many roosters? *
I plan on doing the following with the eggs (check all that apply)*
I will collect eggs:*
I have roosters*
I allow my hens to incubate eggs:
I purchase chicks/chickens from the feed store, mail order hatcheries, and/or breeders:*
These chickens may live another 4-10 years. Their egg production may decline in 1-3 years. Are you prepared to keep these hens the remainder of their lives?: *
Do you have an avian veterinarian?*
Veterinarian Name
I have a temperature controlled area the chicks can be in (at night) until they are large enough?
Do you have experience caring for chicks less than 2-3 months old? Please share.
Coop dimensions (where chickens sleep at night, e.g. 3'x5')*
My coop has (check all that apply):*
My coop includes (check all that apply): *
I clean out my coop:*
Dimension of outdoor run (e.g. 10'x20')*
Fencing Height (e.g. 6'). If fencing is chain link or field fencing, how large are the holes (e.g. 1"x1")*
My outdoor run includes (check all that apply):*
I clean my run:*
I have had chickens killed by predators in the past:*
Describe what happened and what, if anything, was done to fix the problem.
My predator protection includes (check all that apply): *
I feed my chickens:*
I collect feed before the birds are locked up at night?*
I keep chicken feed in an airtight container or a rodent proof shed?*
I use the following to control rodents (check all that apply):*
What is the best time to reach you by phone?:*
How did you hear about Animal Place's adoption program?: *
I'd like to:
Word Verification: