Application -Animal Request

 

Applicant Personal Phone

Address

Name of Animal: Age of Animal:

Physical Description (Color, Breed, Size, Tag, Collar):

Gender Neutered/spayed?

Is animal licensed or registered? With what Agency?

Is the animal specifically trained to work or perform tasks for persons with disabilities?

If you are requesting reasonable accomodation of the animal under Housing Laws you agree to the following;

A. To provide a letter signed with in the last 12 months from your licensed doctor, licensed therapist or other licensed provider which states you have a disability as defined under the ADA, Fair Housing Act or the Rehabilitation act of 1973 and explains how the requested accommodation will be helpful to your needs.

B. To be responsible for the animal's behavior and be financially responsible for the actions of the animal at all times which can exceed the security deposit.

C. To comply with all laws, regulations and rules governing animals.

D. To properly house, care for and feed the animal and properly manage and dispose of all animal waste.

E. To provide a collar or other means of identification of the animal which includes the owner name and a current phone number and maintain any required vaccinations.

Alernate contact for the animal if owner is not available:

Checking this box indicates that informaton in this applicaton is complete and accurate.

Checking this box authorizies the property owner or manager to contact all agencies and individuals noted above and verify the information

Checking this box acknowledges that I am aware my application will not be reviewed or considered officially submitted until the letter requested by line A (above) has been received by the owner/agent..

Checking this box acknowledges that I am aware my application will not be reviewed or considered officially submitted until the application fee is received.

Checking this box confirms that I am the Applicant and I am authorized to provide this information and grant the permissions that have been done in this applicaton.

......Return without sending....