Puppy Interest Application Form

1
Name
First Name
Last Name
2
Address* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
3
E-mail* This field is required.
4
Phone Number - Home
Area Code
Phone Number
5
Phone Number - Cellular
Area Code
Phone Number
6
Which number do you prefer we use?
Home
Cell
Work
7
Do you live in a:
Please Select
Please Select
House
Townhouse
Condo
Apartment
Duplex
Other
8
How were you referred to us?
9
Household setting
Rural
Suburban
Urban
10
Describe your homes activity level
Busy/Noisy
Moderate Comings/Goings
Quiet with Occasional Guests
11
Please list all people living in the household (Include Name, Relationship, Gender and Age)* This field is required.This helps us match the right puppy to the right household.
12
If you have children, are you willing to take on the added tasks of training and exercising a Vizsla? (Remember, a tired Vizsla maker for a happy owner and happy Vizsla!)
Yes
No
13
Does anyone in your household have allergies to animals?
Yes
No
14
Are ALL family members enthusiastic about owning a Vizsla and have you discussed the merits and requirements of the breed?
Yes
No
15
Please list any pets you have living or deceased (Please include Name, Breed, Age, Altered, Sex, UTD Vaccines, Heartworm, Living/Deceased)* This field is required.No more than five
16
Do you have a preference in the gender of your new puppy?
Male
Female
No Preference
17
Are you going to use a crate for your puppy?
Yes
No
18
Do you have a fenced yard?Please note, this will not disqualify you from getting a puppy if you do not have a fenced yard.
Yes
No
Partial
19
Check any/all that apply - Do you want your Vizsla for a....
Hunting Partner
Running/Jogging
Companion
Family Pet
Versatile Vizsla
Therapy
Breeding/Showing/Competition
Other
20
If you selected other, then please explain here:
21
Does your lifestyle give you the time and energy to properly care for and exercise your Vizsla, aka, another member of your Family?
Yes
No
22
What do you do in your leisure time and will you take time to fit a Vizsla into it?
23
Have you considered the financial cost of dog ownership; are you financially prepared to give your new Vizsla the medical care, quality food, training, etc. for its lifetime?
Yes
No
24
Are you, or have you been, fortunate enough to have a Vizsla as a family member?
Yes
No
25
Why are you interested in a Vizsla?
26
Do you have any questions/concerns not addressed by us or our website?
27
Please add any additional information you think would help us select the right dog for you as they will become an integral part of your life and family!
28
We don't want to get lost in the shuffle; would you be willing to add our email address to your contacts so you don't need to worry about our response going to your SPAM folder?
YESNO
Should be Empty: