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    Service Animal Request - Delta Air Lines

    Uploaded by

    Joseph Red
    The document is a service animal air transportation form from the U.S. Department of Transportation that requires handlers to provide information about their service animal like vaccination records, training, and behavior to fly with the animal. It warns that making false statements is a federal crime and handlers must certify the accuracy of the information provided on the form.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Service Animal Request - Delta Air Lines

    Uploaded by

    Joseph Red
    54 views2 pages
    The document is a service animal air transportation form from the U.S. Department of Transportation that requires handlers to provide information about their service animal like vaccination records, training, and behavior to fly with the animal. It warns that making false statements is a federal crime and handlers must certify the accuracy of the information provided on the form.

    Original Description:

    service animal requestt

    Original Title

    Service Animal Request _ Delta Air Lines

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    The document is a service animal air transportation form from the U.S. Department of Transportation that requires handlers to provide information about their service animal like vaccination records, training, and behavior to fly with the animal. It warns that making false statements is a federal crime and handlers must certify the accuracy of the information provided on the form.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    54 views2 pages

    Service Animal Request - Delta Air Lines

    Uploaded by

    Joseph Red
    The document is a service animal air transportation form from the U.S. Department of Transportation that requires handlers to provide information about their service animal like vaccination records, training, and behavior to fly with the animal. It warns that making false statements is a federal crime and handlers must certify the accuracy of the information provided on the form.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    U.S.

    Department of Transportation Service Animal Air Transportation Form


    According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to
    respond to, a collection of information unless it displays a valid OMB control number. The estimated burden to complete
    this form is 15 minutes. The OMB control number for this information collection is 2105-0576.

    The authority for the collection expires on December 31, 2023.

    Warning: It is a federal crime to make materially false, fictitious, or fraudulent statements, entries, or representations
    knowingly and willfully on this form to secure disability accommodations provided under regulations of the United States
    Department of Transportation (18 U.S.C. § 1001).

    Basic Information
    All fields required unless noted

    Service Animal Handler's Name Service Animal Handler's Phone

    Joseph Red 951-634-3267

    Service Animal User's Name (Opt.) Service Animal User's Phone (Opt.)

    -- --

    Service Animal Handler's Email Animal's Name

    [email protected] Snow Winds Poppy Red

    Description of animal (including weight) 120 Character Maximum

    Tan and White 15#

    Animal Health

    By checking each requirement below you are confirming the information provided is correct:

    Service Animal is vaccinated for rabies

    Date of last vaccination Date of vaccination expires in the dog

    Dec 28, 2021 Dec 28, 2023

    To my Knowledge, Service Animal does not have fleas or ticks or a disease that would endanger people or other
    animals.

    Veterinarian's Name Veterinarian's Phone

    VCA 509-467-5230
    Animal Training and Behavior

    Service Animal has been trained to do work or perform tasks to assist me with my disability.

    Name of Animal Trainer/Training Org Phone# of Animal Trainer/Training Org

    Joe Red 951-634-3267

    Service Animal has been trained to behave in a public setting.

    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 does not
    urinate or defecate on the aircraft or in the gate area.

    I understand that if Service Animal shows that it has not been properly trained to behave in public, then the airline
    may treat Service Animal as a pet by charging a pet fee and requiring Service Animal to be transported in a pet carrier.

    To the best of my knowledge, Service Animal has not behaved aggressively or caused serious injury to another person/dog.

    Yes No / Not Sure

    Other Assurance

    I understand that Service Animal must be harnessed, leashed, or tethered at all times in the airport and on the
    aircraft.

    I understand that if Service Animal 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.

    I am signing an official document of the U.S. 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.

    By typing my name below, I certify that I have read and completed the form above accurately and completely to the
    best of my knowledge.

    Your Full Name Date

    Joseph Red Sep 5, 2022

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