Apply to Adopt a Senior Pet

Name of Newman Nation Animal *

Name *

First

Last

Email *

Primary Phone Number *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

What is your residence type? *

Do you... *

Own
Rent

If you lease, please provide your landlord's name and contact information.

Do you have a fenced-in yard? *

Yes
No

Please note that this is NOT a requirement for adoption.

Marital Status *

Please list the names, ages, and relationships of all (human) members in your current residence, including yourself: *

Does anyone in your residence have pet allergies? *

Yes
No

If yes, please explain:

Are you currently employed? *

Yes
No

Is anyone home during the day? *

Yes
No
Sometimes

Please list the names, ages, species, genders, breeds of all animals in your residence: *

Are all your current pets spayed or neutered? *

Yes
No

If no, please explain:

Name of Your Primary Vet Clinic *

Please note that we will call for a vet reference as part of our adoption application process.

Phone Number for Your Primary Vet *

Please explain why you are interested in adopting this senior animal. *

Are you willing/able to adopt an animal with a disability (ex. blind, deaf, mobility impairment, etc.) *

Yes
No

Please note that if you check "no," we can not guarantee that the senior animal will not develop a disability in the future. Please keep this in mind.

Are you willing/able to adopt an animal that requires specialized care (ex. special diet, medications, etc.) *

Yes
No

Please note that if you check "no," we can not guarantee that the senior animal will not require specialized care in the future. Please keep this in mind.

I understand that submitting this application is not a guarantee of adoption. Newman Nation works to find the best fit for each individual animal and it is not first-come, first-served. *

I agree