Apply to Adopt a Senior Pet Please enable JavaScript in your browser to complete this form.Name of Newman Nation Animal *Name *FirstLastEmail *Primary Phone Number *Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeWhat is your residence type? *HouseTownhomeCondoApartmentOtherDo you... *OwnRentIf you lease, please provide your landlord's name and contact information.Do you have a fenced-in yard? *YesNoPlease 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? *YesNoIf yes, please explain:Are you currently employed? *YesNoIs anyone home during the day? *YesNoSometimesPlease list the names, ages, species, genders, breeds of all animals in your residence: *Are all your current pets spayed or neutered? *YesNoIf 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.) *YesNoPlease 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.) *YesNoPlease 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 agreeSubmit