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Service Animal Agreement: JLIF-3

  • Students: J
Service Animal Agreement: JLIF-3

Student or Employee Name: ______________________________________________________

Parent/Guardian Name: __________________________________________________________

Owner/Handler Name (if different than parent) _______________________________________

Type of Animal: [ ] Dog [ ] Miniature Horse

Task(s) animal is trained to perform: __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________


1. I have attached the following:

  • a. Documentation that the service animal is properly trained and licensed
  • b. Certification of proper and current vaccinations verified by a veterinarian
  • c. Documentation that the student, as the handler of the service animal, is properly trained; and
  • d. Documentation of adequate liability insurance.

2. I understand and agree that the student/employee is solely responsible for the care, feeding, and toileting of the service animal and is expected to have control of the animal at all times through the use of harness, leash, tether or voice commands.

3. I understand and agree that the animal will be kept clean and groomed to avoid shedding and dander. The animal will be treated for, and kept free of, fleas and ticks.

4. I understand and agree that the District may exclude my Service Animal if: (a) the animal is out of control and the animal’s handler, does not take effective action to control it; (b) the animal is not housebroken; (c) the animal poses a direct threat to the health or safety of others; or (d) for any other reason permitted by law.

5. I understand and agree that I am responsible for any and all damage caused by my Service Animal to District property or to the property of others and for any and all injuries caused by my Service Animal to any person. I also agree to indemnify, defend and hold harmless the District from and against any and all claims, actions, suits, judgments and demands brought by any party arising on account of, or in connection with, any activity, damage or injury caused by my Service Animal.

Signature of Parent/Guardian/Employee: _______________________________Date: _________________

Signature of Owner/Handler: ________________________________________Date: _________________

Note: This Agreement is valid until the end of the current school year. It must be renewed prior to the start of each subsequent school year or whenever a different Service Animal will be used. A completed copy of the agreement should be maintained in the student’s cumulative file or the employee’s personnel file, whichever is applicable.