General Information

    Name: Age:
    Address:
    City: State Zip
    Occupation:

    Email Address:
    How regularly do you check your email?
    Throughout the DayDailyWeekly
    Where would you prefer we contact you?
    HomeWork
    What is that number?
    Best time to call?
    MorningAfternoonEveningAnytime

    Type of Housing

    Own HouseOwn CondoRent HouseRent Apartment
    Landlord's name
    Landlord's phone
    How long at present address
    Do you have a yard? YesNo
    Is the yard securely fenced? YesNo
    Please briefly describe the fence

    Do you have an outdoor kennel? YesNo
    Please briefly describe kennel

    Do you have a pool YesNo

    Family Information

    Other Adults in Household:
    Adult 1: Age:
    Occupation
    Adult 2: Age:
    Occupation
    Adult 3: Age:
    Occupation
    Children in household? YesNo
    If so, their ages:
    Child 1: Child 2: Child 3:
    Anyone have any known allergies to domestic pets? YesNo

    Current Pets (Please include all pets)

    Pet 1: Age: SpayedNeuteredIntact
    Breed:
    Pet 2: Age: SpayedNeuteredIntact
    Breed:
    Pet 3: Age: SpayedNeuteredIntact
    Breed:

    Pet History

    Past Pets:
    Kept: IndoorOutdoorBoth
    Time Owned:
    What happened to them?

    Vizsla Information

    Vizslas are high-energy dogs. How will you see that your Vizsla gets exercise?

    All dogs need training. What are your thoughts on this and the types of training?

    Please describe in detail any interaction you’ve had with the Vizsla breed, including (but not limited to) other owners you have spoken to, books you have read, Vizslas you have met, etc. Also please give a general description of your knowledge of the breed:

    What about the Vizsla appeals to you?

    We recommend that you come to our home and meet our dogs and see their surroundings. Would you like an opportunity to come for a visit?
    YesNo
    Information regarding the dog you are interested in:
    Gender: MaleFemaleFlexible
    Age preference: Flexible
    Temperament:
    Reason for wanting a Vizsla:

    We all have our own ideas of how much family time ought to include the dog(s). Where will you keep the Vizsla while you are at work or away from home?

    On vacation?

    Running errands?

    Where will the Vizsla sleep at night?

    Lifestyle

    Describe your typical day on a weekday:

    A weekend day:

    What changes in your life (new baby, grandchildren, home, job re-location) are you anticipating in the next year?

    5-year changes:

    Please outline any other expectations or concerns you may have

    Reference Information

    Please provide two personal references whom we may contact. References should know you and your home well, and should be unrelated to you. Please provide names, addresses and phone numbers.

    Reference 1
    Name:
    Address:
    City: State Zip
    Phone Number:

    Reference 2
    Name:
    Address:
    City: State: Zip
    Phone Number:

    Current Veterinarian:
    Phone Number:

    May we share your application with other rescue groups?
    YesNo

    I certify that all of the information in this application is true and correct.
    I understand that false information may void the application.

    You must fill in each field in order to submit your application.
    Any blank fields will result in an error in the submission.

    We greatly appreciate your taking the time to fill out this form, and appreciate your interest in our dogs. We will get back to you regarding your request very shortly!