General Information

Name: Age:
City: State Zip

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

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:
Adult 2: Age:
Adult 3: Age:
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
Pet 2: Age: SpayedNeuteredIntact
Pet 3: Age: SpayedNeuteredIntact

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?
Information regarding the dog you are interested in:
Gender: MaleFemaleFlexible
Age preference: Flexible
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?


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
City: State Zip
Phone Number:

Reference 2
City: State: Zip
Phone Number:

Current Veterinarian:
Phone Number:

May we share your application with other rescue groups?

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!