Service Animal And Handler/partner Registration Form

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For Office Use Only
UGA Registration #: ____________
Tags will be provided to Registrants
Service Animal
University of Georgia
SERVICE ANIMAL AND HANDLER/PARTNER REGISTRATION
For Faculty, Staff, Administration and Retirees
“Handlers” are those people with disabilities who are assisted by a “Service Animal” as defined by the UGA
Policy Regarding Service Animal Access to University of Georgia Facilities, Programs, Services and Activities.
Registration of Handlers, although not mandatory, is encouraged.
“Partners” are those who accompany dogs being trained to be service animals for “Handlers.” Partners may
not have their service animals in training when they are scheduled to be at work or perform work-related
activities.
“Designated Alternate Custodians” are all persons accompanying dogs on behalf of service animal “Handlers”
or “Partners.” Alternate Custodians are not authorized to have the service animal under their care until they
have been registered as such by “Handlers” or “Partners,” who shall provide their information, below.
Please present this completed form and evidence of your credentialing as a Handler or Partner (e.g. ID card or
letter on letterhead of organization) from a service animal organization.
Please PRINT:
Handler/Partner
Name: ________________________________________
Local Phone: ______________________________ Email: ______________________________
Local Address: ______________________________________________________________________
UGA Unit: ______________________________________________________________________________
Service Animal
Name of Service Animal: _____________________________
Description of Service Animal: Breed: ________________ Color: _________________ Size______________
Coat __________________ Other: __________________________________________________________
Service Animal Organization
Evidence of credentialing as a Partner from a service animal organization is attached: Yes ___ No ___
Organization Name:
_____________________________________________
Contact Person:
_____________________________________________
Telephone Number:
_____________________________________________
Email address:
_____________________________________________
Mailing Address:
_____________________________________________

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