Passenger Confirmation of Liability
and Emotional Support/Psychiatric
Service Animal Behavior Form
This form must be completed by the passenger.
Passenger name (print):
Animal type:
Animal breed:
Animal weight:
If the animal weighs more than 65 pounds, United will evaluate on a case-by-case basis whether the animal may safely travel on the speciÿc °ight(s).
Initial
I am not aware of any reason to believe that this animal would pose a direct threat to the health
or safety of others.
I am not aware of any reason to believe that this animal would cause a signiÿcant disruption to
service in an aircraft cabin.
I am not aware of any reason to believe that this animal would be too large or heavy to be
accommodated under the seat/foot space onboard a typical airline aircraft.
If outside of a kennel,
- this animal takes direction upon my command and will remain under my control at all times,
and
- I conÿrm that this animal has been trained to behave properly in a public setting.
I understand that if my animal acts inappropriately or exhibits unsafe or untrained behavior,
United Airlines may only accept it in accordance with its current pet policies, may deny the
animal boarding and/or remove it from the aircraft.
I assume full responsibility for the safety, sanitation (the animal not relieving itself in °ight),
well-being and conduct of my animal, including the interaction of the animal with crew and other
passengers or passenger property that may come in contact with the animal while on board the
aircraft, and for compliance with all UA and governmental requirements, regulations, or
restrictions, including entry permits and required health certiÿcates of the country, state, or
territory from and/or to which the animal is being transported.
If the representations above are untrue or if my animal does not comply with United's policies
for the acceptance of emotional support animals and I cause United Airlines or its passengers
any loss, damages or expense of any kind, I consent and acknowledge that I will reimburse it for
any such loss, damage, or expense.
Signature:
Date:
Phone contact:
Email contact:
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signature
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