Service Dog and Emotional Support Animal Registration Form
This form must be submitted and approved prior to animal occupying the assigned space.
To be Completed by the Student
Requested Semester for Animal in Residence Hall
*
Animal Owner's Name (Student)
*
First Name
Last Name
Navarro College Student Identification Number
*
Navarro College Email
*
Animal Information
Enter the animal's details and upload required records.
Animal Type (e.g. dog, cat, etc.)
*
Breed
*
Age
*
Color
*
Upload Photo of Animal
*
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of
Rabies Vaccination Date (most recent)
*
/
Month
/
Day
Year
Date
Upload Rabies Vaccination Record
*
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of
Spay or Neuter Date
*
/
Month
/
Day
Year
Date
Upload Spay or Neuter Record
*
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of
Certificate of Health Date
*
/
Month
/
Day
Year
Date
Upload Certificate of Health Record
*
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of
Acknowledgment Terms
Please review the statements below and check each box to acknowledge your understanding and agreement. These acknowledgments confirm that you have read the required procedures and understand your responsibilities related to having a service or assistance animal in campus housing.
Your Signature
Signature Date
*
/
Month
/
Day
Year
Date will be captured on form submission.
Printed Name
*
Building Number
*
Room Number
*
Submit
Submit
Should be Empty: