Rehome a Vizsla

Phone Number

Area CodePhone Number
Email
example@example.com
Request to Rehome a Vizsla
This form contains a lot of questions. You can save the form and return to complete it later. We ask for scanned pdfs or jpgs of the following so please have these handy / available to upload.
- Registration (Ownership) form - if available
- Vaccination Certificate
- Photos of your Vizsla
Date of Application*

MonthDayYear
Date

Open Form
Owner / Breeder / Executor Information
I am / we are the:*

Legal Owner(s) / Co-owner(s)Breeder (but not a legal owner)ExecutorOther
If the owner is deceased, please scan & upload a copy of the death certificate / obituary.

Upload Files

Cancelof
Name(s) in Full*
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail*
Tel 1
Tel 2
Dog's Info & Vitals
Dog's Call Name*
E.g., Fido
Dog's Registered Name (If known)
Dog's Date of Birth or approximate Age*
Breed / Type*

Vizsla Smooth (short coat)Vizsla WirehairVizsla MixOther
Gender*

MaleFemale
Reproductive Status*

IntactNeutered / Spayed
Date (year and month) of neutering / spaying
Tail*

DockedUndocked (i.e., full length)
Dewclaws*

RemovedPresent
(Approx) Height (inches)*
From floor to top of the shoulders
(Approx) Weight (lb)*
Other physical description (e.g., markings)
Indicate which organization the dog is registered with i.e., does the dog have its "papers"?*

Do not know (I'm the executor, or caretaker)No / NoneCdn Kennel ClubAmerican Kennel ClubUnited Kennel ClubOther
Scan & upload a copy of dog's registration papers

Upload Files

Cancelof

Microchip or tattoo? Please supply ID number.

	Dog's ID
Tattoo #
Microchip #
Microchip Company

Reason for rehoming this Vizsla?*
What are this Vizsla's 5 best qualities?*
What are this Vizsla's 3 least attractive qualities?*
What kind of family / home situation would best fit this dog's needs?*
Where / from whom was this Vizsla acquired?*

Reg'd Vizsla BreederAd (newspaper/online)Rescue organizationNeighbour / friendOwner is deceased; acting as executorFound / adopted as a strayOther
How old was the Vizsla when it was acquired by you or the owner?*
How long has s/he lived with you / current family? *
How many previous homes has this dog had (other than the breeder's)?*

031More than 32Do not knowOther
Breeder's Name(s)
If you can't recall or do know know, pls enter Do Not Recall / Do Not Know
Breeder's Address
Please supply as much information as possible, even the last known address / or city.
Breeder's Email
example@example.com
Breeder's Telephone

Area CodePhone Number
Is there a written contract with the breeder?

YesNoDo Not Know
Does the contract require the dog to be returned to the breeder?

YesCan't recall / do not knowNoNot applicable in this situation
Has this dog's breeder been contacted to take the dog back?

YesNo
If YES, please explain the dog is not being returned to the breeder. If NO, please explain why you haven't contacted the breeder?
Where is the dog currently residing / staying?*

With me/my familyWith someone elseOther
If the dog is currently staying / residing with someone other than you /your family, please explain the circumstances and why, along with the address.
Dog's Home Situation
# of ADULTS (18 years of age or older) living with the Vizsla?*
# of CHILDREN (under 18) in the home?*

List age(s) of all children living with the Vizsla.

	Age
Child 1
Child 2
Child 3
Child 4
Child 5

Which best describes the propery in which this dog lives?*

HouseApt / CondoTownhomeOther
In the day, where does this dog spend most of its time?*

IndoorsOutdoorsDo not knowOther
At night, where does this dog usually sleep?*

In bed with or next to family memberIn a crateLoose in the houseLocked in a roomOutdoors - dog house / kennel runOther
How many hours / day on average is the dog left unaccompanied at home?*
Type of Food Fed*

Dry / KibbleCannedRawCookedComboOther
If dry and/or canned, what brand and protein do you feed?
Provide other relevant home information that has not been covered.
Behaviour

How good is this dog with the following? Not Good, Somewhat Good, Mostly Good, Great, Don't Know, Not Applicable*

	NOT good	Somewhat	Mostly	Great	DK	NA	Explain
Babies / Toddlers
Young Children
Strangers in general
Men
Women
Puppies
INTACT male dogs
NEUTERED male dogs
Female dogs
Cats

How anxious / fearful is this dog with the following?*

	Very	Somewhat	Not at all	Don't Know	Not Applicable
Thunder storms
Guns
Fireworks
Vacuums
Wind
Being crated
Car travel
Vet visits
Strange dogs
Nail trimming

Please describe in more detail what this Vizsla does re: the fear/anxiety behaviours above and how they are dealt with / managed.
Has your Vizsla displayed ANY of the following behaviours? Tick ALL that apply.

Mouthes arms or handsGrowls, bares teeth, tries to bite if someone gets close to its food bowl, treats, bed, toysAggression to people (e.g., bares teeth, snarls, lunges)Unprovoked aggression to dogs / attempts to attack another dogAggression to INTACT MALE dogs (e.g., bares teeth, snarls, lunges)Aggression to NEUTERED male dogs (e.g., bares teeth, snarls, lunges)Aggression to FEMALE dogs (e.g., bares teeth, snarls, lunges)Cries, pants, urinates, howls, destroys things when left aloneBarks excessively, either or both when left alone or in the home with its familyExtremely shy / submissive with strangers & dogsDestroys furniture, dog beds, crates, etc.Escapes yard / runs awayJumps fencesDigs holesChases cars / bikers / livestock etc.Other
Has this dog ever been prescribed medication by a veterinarian to deal with anxiety, fear, or aggression?

YesNoNot sure because I am the executor / caretakerOther
If YES, please note the drug and the behaviour for which it was prescribed below.
Please provide additional details about the bahviours above and they have been handled / managed.
What things does your Vizsla guard or protect by growling / baring teeth / lunging? Tick all that apply.

Its crateDog bed outside of its crateCouches & chairs (i.e., human furniture)ToysFood bowlRawhide / bully sticks / hooves, i.e., high value treats etc.People (e.g., wife or husband)NothingOther
Please provide additional details about the guarding behaviour and they have been handled / managed.
Has this Vizsla ever bitten or attempted to bite people?

YesNo
Has this Vizsla ever bitten or attacked, or tried to bite or attack other animals (e.g., dogs, cats, livestock)?

YesNo
Dr. Ian Dunbar's Bite Scale Index

Level 1. Obnoxious or aggressive behavior but no skin-contact by teeth.

Level 2. Skin-contact by teeth but no skin-puncture. However, may be skin nicks (less than one tenth of an inch deep) and slight bleeding caused by forward or lateral movement of teeth against skin, but no vertical punctures.

Level 3. One to four punctures from a single bite with no puncture deeper than half the length of the dog’s canine teeth. Maybe lacerations in a single direction, caused by victim pulling limb away, owner pulling dog away, or gravity (little dog jumps, bites and drops to floor).

Level 4. One to four punctures from a single bite with at least one puncture deeper than half the length of the dog’s canine teeth. May also have deep bruising around the wound (dog held on for N seconds and bore down) or lacerations in both directions (dog held on and shook its head from side to side).

Level 5. Multiple-bite incident with at least two Level 4 bites or multiple-attack incident with at least one Level 4 bite in each.

Level 6. Victim dead.
Please list & describe each biting incident separately below in as much detail as possible including the: date of occurence, age of your dog at the time of the bite, what it inflicted the bite on (adult, child, dog, cat, etc.), the circumstances / triggers that led to the bite, etc. along with the bite level using the Bite Scale Index above.
Biting incidents
Exercise & Training

Dog's general energy level*

	1	2	3	4	5

1 is Low, 5 is High

On average, how much exercise (e.g., running, walking, playtime) does this Vizsla get per day?
Describe this Vizsla's typical daily exercise routine.*
E.g., on leash, dog parks, swimming, walking, hiking, etc.
Describe what types and levels of training this dog has had. *
Include name of school / trainer / company, # of sessions, level etc.
What type of collar does your Vizsla typically wear each day? (I.e., not during training)*

Flat collarChoke chainProng / pinchElectronic (shock)Bark collarOther
What type of collar does your Vizsla USUALLY wear during / for TRAINING?*

Flat collarChoke chainProng / pinchElectronic (shock)Bark collarOther
What training methods have been used with this Vizsla?*

Force-free / positive reinforcement to reward desired behaviours i.e., using treats, toysNegative reinforcement / punishment to stop bad behaviours i.e., collar pops, e-collar, slapping, spray bottle, etc.Both
In your experience, which training method has been used more freqently to modify your Vizsla's behaviours?

How good is this dog at the following behaviours? *

	Not at all	Somewhat	Pretty good	Fantastic
House broken
Crate trained
Walks nicely on leash
Comes when called
Sits on command
Stays on command
Jumps on people
Stays off kitchen counters
Travels well in a car
Does tricks
Knows 'place' or 'mat'

Health
Are this dog's vaccinations up-to-date?*

YesNo
If no, please explain
Please scan & upload the vaccination certificate / record

Upload vacc record

Cancelof

Current medications*

	Drug / Product Name
None
Heartworm prevention
Flea/tick prevention
Thyroid
Antibiotics
Cortisone
Seizure meds
Anti-anxiety meds
Other
Other

List and describe known health problems / issues
Does this dog have health insurance?

YesNoNo sure / Don't know
If yes, please provide the name of the insurance company and the policy / plan #.
Name of the dog's veterinarian / veterinary clinic
Veteterian's / Clinic's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Veterinarian's Phone Number

Area CodePhone Number
Additional Information about this dog's health or its situation that you would like the VSO to know.
Certification, Release, & Privacy
Date

MonthDayYear
Date
Name of Vizsla
Assuming that the Vizsla Society of Ontario Inc. (“VSO”) accepts the above-named Vizsla into its rehoming program to find a new home, you are asked to complete the following:
Name of Legal Owner / Legal Representative
I attest and certify that to the best of my knowledge I have disclosed all information concerning the health, behavior, history and anything else that may affect the safe placement of this Vizsla in another home.*

Yes
I certify and agree to the following:*

I am the legal owner and / or I have the authority to surrender this dog to the VSO.To sign any and ALL ownership papers (if available) to transfer legal ownership to a new owner.To relinquish all rights of ownership once the dog is surrendered to the VSO.To authorize the release of any and all veterinary records subject to approval by the vet.
I authorize the VSO to provide my name and contact info to the new owner, if needed.*

YesNo
I will indemnify, release and hold harmless the Vizsla Society of Ontario Inc. and their respective directors, officers, employees, members, and their successors and assigns (collectively, the "Indemnified Parties") against any claims, demands, actions, causes of action, or liability of any kind whatsoever arising as a result of or in connection with the adoption or other disposition of the above named Vizsla.
I have read and agree to the above Indemnification and Release.*

Yes
PIPEDA - Collection, Protection and Use of Personal InformationUnder the Personal Information Protection and Electronic Documents Act (S.C. 2000, c. 5), the Vizsla Society of Ontario Inc. [VSO] collects personal data including name, address, telephone and email information for the purpose of establishing eligibility of membership and elections, distributing materials relating to club business, and to operate its services and programs including its Rescue / Rehoming program. The VSO does not and will not share, publish, sell, or distribute personal information to/with other organizations without written consent of its members or applicants.
I have read and give consent to the VSO for the collection and use of my/our personal information for the purposes noted above. **

Yes
Signature (use mouse or touch screen/pad to sign)*

Clear
Scan & upload up to 10 CURRENT photos of this dog

Upload photos

Cancelof
Should be Empty:

Request to Rehome a Vizsla

Owner / Breeder / Executor Information

Dog's Info & Vitals

Dog's Home Situation

Behaviour

Exercise & Training

Health

Certification, Release, & Privacy