Service Animal Registry of America TM
Therapy Animal Registration Application Form

Attach Therapy Animal Color Photo (No copies/printouts) Print and mail to:
Checks and 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 $20. (10 business day turnaround) Rush: Money orders only PLUS: SHIPPING/HANDLING: $7.00 TX residents add 6.75% sales tax

Handler Name:____________________________________________
Address:__________________________________________________
City:__________________________State:_____________Zip:__________
Home Phone#:____________________Work#:________________
Email:________________________________________________________
Therapy Animal Information

Species:_________________________________________________________
Breed:__________________________________________________________
Sex:__________________Age/DOB:________________Color:___________
Call Name:_____________________________________________________
Date placed in service:__________SARA# (renewal only)_________________
Primary Functions:___________________________________________
________________________________________________________________ Trainer/Instructor Information (If self, use your name)

Name:__________________________________________________________
City:________________________________________State:____________

I hereby attest that the above named animal's function is as a Therapy Animal 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 declare under penalty of perjury that the foregoing is true and correct.

 __________________________ Handler Signature  Date:__________

Office Use Only

Denied________Approved___________ SARA#______________Date Issued:______________________