ALL fields are required
Type of Animal:
Physical Description of Animal:
Please email the Veterinarian's verification that the animal has all Veterinary recommended vaccinations to maintain the animal's health and prevent contagious disease.
Please review each area and initial each paragraph. The student requesting the Emotional Support Animal (ESA) must complete this form. If the student is under age 18, then the parent will also sign the agreement. By initialing and submitting this document, you are acknowledging your responsibilities as Owner/Handler.
IN CASE OF AN EMERGENCY
Please provide the names, phone numbers, and email addresses of 2 persons who can come to campus and get your ESA.
I have read and agree to all of the terms of MSUM Accessibility Resources, Housing & Residential Life Emotional Support Animal (ESA) Agreement.