Service Animal | Requirement Checklist
| IMPORTANT NOTICE:
The district will provide access to a person with a disability who needs a service animal
provided that the tasks performed by the service animal are directly related to the disability,
and that the animal has been individually trained to perform a task, is housebroken, is free of
disease and parasites, has a harness, leash or tether so it cannot run free, and is under the
control of the person with the disability. A service animal must also be licensed and immunized in accordance with the laws, regulations, and ordinances of the city, the county, and the state of Washington. (EPS School Board Procedure 2030P) |
Type of Animal: Animal’s Name (if applicable):
Student Name: Student Id:
School Location:
Graduation Year:
Description of the task(s) the service animal is expected to perform in assisting the person with a disability:
Before a service animal will be permitted in school, on school property or at school-sponsored events,
there are specific items related to health, hygiene, and behavior that are important to have in place.
Please
attach documentation that will be helpful
to establish the following:
[ ]
The animal is housebroken
[ ] The animal is free from disease and parasites
[ ] The animal has a harness, leash, or tether so it cannot run free
[ ] If a parent or animal handler is not present, the animal is consistently under control of the person with the disability
The animal is [ ] licensed and [ ] immunized in accordance with the laws, regulations, and ordinances of the city, the county, and the state of Washington.
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________________________________
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Parent/Guardian Name (printed)
Parent/Guardian Signature
Date
Copies: 1) Parent/Guardian, 2) Principal or designee, 3) Upload to Special Programs