Adoption Form


PLEASE COMPLETE ALL FIELDS unless noted otherwise
Name:
Age:
Address:	street) (city) (state/zip)	*How Long?*
E-Mail Address:
Where would you prefer we contact you?:	Work Home
What is that number (area code included) and best time to call?:		Mornings Afternoons Evenings Weekend
How regularly do you check your e-mail?:
Name/phone number of Vet: (if applicable)
Check type of housing:	Own house Own Condo Rent house Rent apartment Other (please describe)
Landlord&iacutes name & Phone (if renting):
Our neighborhood/property is:	Rural Suburban Urban City Other
Do you have a yard?:	Yes No If yes, is the yard securely fenced? Yes No
Please describe your fence briefly (material, age, height, etc.):
Do you have an outdoor kennel?:	Yes No Please describe material, top, base surface):
Do you have a pool?:	Yes No
Number of household members?:	Adults Children Children's Ages
Are they in accord with owning a Vizsla?	Yes No Undecided
What will their relationship be to the Vizsla?
Who will be responsible for the care and exercising of the dog?
Please tell us anything further about your family that youíd like to share:

Current Pets (Please Include all Pets): (if applicable)
Pet 1:	Type: Sex: Age: Spayed/Neutered? Yes No Is Pet kept inside? Yes No How long have you owned?
Pet 2:	Type: Sex: Age: Spayed/Neutered? Yes No Is Pet kept inside? Yes No How long have you owned?
Pet 3:	Type: Sex: Age: Spayed/Neutered? Yes No Is Pet kept inside? Yes No How long have you owned?
Pet 4:	Type: Sex: Age: Spayed/Neutered? Yes No Is Pet kept inside? Yes No How long have you owned?

Pet History (List pets previously owned): (if applicable)
Pet 1:	Type: Sex: Age: Neutered? Yes No Was Pet kept inside? Yes No How long did you own? What happened to pet?
Pet 2:	Type: Sex: Age: Neutered? Yes No Was Pet kept inside? Yes No How long did you own? What happened to pet?
Pet 3:	Type: Sex: Age: Neutered? Yes No Was Pet kept inside? Yes No How long did you own? What happened to pet?
Pet 4:	Type: Sex: Age: Neutered? Yes No Was Pet kept inside? Yes No How long did you own? What happened to pet?

Any known allergies to domestic pets?	Yes No
What changes in your life (new baby, grandchildren, home, job re-location) are you anticipating in the next year?
5 Years?
Vizslas are high-energy dogs. How will you see that your Vizsla gets exercise?
Most dogs, especially rescues, need training, retraining or refreshers.What are your thoughts on this?
Sometimes we are called about Vizsla mixes needing homes. Are you interested in being contacted about a Vizsla mix?
Some times rescue Vizslas display unacceptable behavior such as fear, aggression, or poor housebreaking. What knowledge and experience can you offer to provide training, understanding and love to your rescued Vizsla?
If we have no Vizslas in Northern California needing homes, would you like us to share your application with other Vizsla rescue groups in the United States?	Yes No
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:
Would you like an opportunity to visit with a Vizsla? Or, have one visit you?	Yes No
If someone referred you to Vizsla Club of Northern California Rescue, please tell us so that we may thank them:
Reason for wanting a Vizsla?	Watchdog Companion Hunter House Pet For Children Companion for other Pet Other (explain):
Information regarding the dog you are interested in:	Gender: Male Female Either Age Preference: Temperament (i.e., playful, quiet, mature, etc.)
What about the Vizsla appeals to you?
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
Describe your typical weekend
Please outline any other expectations or concerns you may have:
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 One:	Name: Address: Phone: Relationship:
	Reference Two:	Name: Address: Phone: Relationship:
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! I certify that all of the information in this application is true and correct and I understand that false information may void the application. >