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!