[NAGDU] Air travel forms

[Jenine Stanley]

From the PDF document containing the full text of the final rule: 


Warning: It is a Federal crime to make materially false, fictitious, or fraudulent statements, entries, or representation knowingly and willfully on this form to secure disability accommodations provided under regulations of the United States Department of Transportation (18 USC Section 1001).

DOT logo

US Department of Transportation Service Animal Air Transportation Form

Service Animal Handler’s Name
Phone
Service Animal User’s Name (if different from Handler)
Phone
Service Animal Handler’s Email
Animal’s Name
Description of the Animal (including weight)

Animal Health followed by a bold line
Checkbox: [Insert Animal’s Name] is vaccinated for rabies.  Date of last vaccination.  Date vaccination expires in the dog.
Checkbox: To my knowledge [Insert Animal’s Name] does not have fleas or ticks or a disease that would endanger people or other animals.
Veterinarian’s Name (signature not required)
Phone

Animal Training and Behavior followed by a bold line
Checkbox: [Insert Animal’s Name] has been trained to do work or perform tasks to assist me with my disability.
Name of Animal Trainer or Training Organization
Phone
Checkbox: [Insert Animal’s Name} has been trained to behave in a public setting.
Checkbox: I understand that a properly trained dog remains under the control of its handler.  I understand that a properly trained dog does not act aggressively by biting, barking, jumping, lunging, or injuring people or other animals.  It also does not urinate or defecate on the aircraft or in the gate area.
Checkbox: I understand that if [Insert Animal’s Name] shows that it has not been properly trained to behave in public, then the airline may treat [Insert Animal’s Name] as a pet by charging a pet fee and requiring [Insert Animal’s Name] to be transported in an FAA-approved pet carrier.
Checkbox: To the best of my knowledge, [Insert Animal’s Nam] has not behaved aggressively or caused serious injury to another person/dog.  If you cannot check the box above, please explain.

Other Assurance followed by a bold line
Checkbox: I understand that [Insert Animal’s Name] must be harnessed, leashed, or tethered at all times in the airport and on the aircraft.
Checkbox: I understand that if [Insert Animal’s Name] causes damage, then the airline may charge me for the cost to repair it, as long as the airline would also charge passengers without disabilities to repair the similar kinds of damage.
Checkbox: I am signing an official document of the US Department of Transportation.  My answers are true to the best of my knowledge.  I understand that if I knowingly make false statements on this document, I can be subject to fines and other penalties.
Signature of the Service Animal Handler
Date