Service Animal Registry of America TM

not affiliated with any government agency

Service Animal Registration Form

Attach Service Animal Color Photo (No copies/printouts) Print and mail to:
Checks, money orders accepted

SARA PO Box 607 Midlothian, TX. 76065 VoiceMail: (206) 376-8931 Email: saraorg@aol.com www.affluent.net/sara

Fees: Certification/Registration: $40. Duplicate Certificate: $15. Additional Photo ID Card $15. RUSH SERVICE $20. (10 business day turnaround) Rush: Money orders only PLUS: SHIPPING/HANDLING: $7.00 per order TX residents add 6.75% sales tax

Disabled Handler Name:_______________________________________
Address:_____________________________________________________
City:__________________________State:_____________Zip:____________
Home Phone#:________________________Work#:____________________
Email:_________________________________________________________
Your Disability?:________________________________________________

Service Animal Information

Species:_________________________________________________________
Breed:__________________________________________________________
Sex:__________________Age/DOB:________________Color:__________

Call Name:___________________________________________________
Date placed in service:_____________SARA# (renewal only)___________________
Trained Tasks:________________________________________________
________________________________________________________________
________________________________________________________________
Trainer/Instructor Information (If self, use your name)

Name:__________________________________________________________
Address:_________________City:____________ State:_____Zip_________

I/we hereby attest that the handler has a qualified disability under the Americans with Disabilities Act; and the above named animal's primary function is as a service animal for the benefit of its disabled handler, and that the animal is qualified by training, is well behaved in public, and is under the safe control of its handler while working. I/we declare under penalty of perjury that the foregoing is true and correct.

_____________________________________Handler Signature    Date:_________
_____________________________________Witness Signature     Date:_________
Witness printed name:__________________________Ph#:____________________

Office Use Only

Denied________        Approved___________ SARA#__________________ Date Issued:_____________