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SERVICE ANIMAL FORM MEDICAL DEPARTMENT

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  • 10 check-boxes
  • 31 other fields

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File type: PDF

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SERVICE ANIMAL FORM
MEDICAL DEPARTMENT
MONDAY TO FRIDAY:
6 a.m. – 10 p.m. ET
SATURDAY TO SUNDAY:
6 a.m. – 8 p.m. ET
EMAIL:
acmedical@aircanada.ca
TEL:
1-800-667-4732
(Toll-free from North America)
1-514-369-7039
(Long distance charges apply)
FAX:
1-888-334-7717
1-514-828-0027
To ensure an efficient process, please complete and submit this form to acmedical@aircanada.ca at least 48 hours
in advance of travel.
Please ensure to keep the completed form with you at all times while travelling.
Please note that should the form not be provided at least 48 hours in advance of travel, your service animal may be
refused travel at the airport.
SERVICE ANIMAL AND USER / HANDLER’S INFORMATION
SERVICE ANIMAL HANDLER’S SURNAME
SERVICE ANIMAL HANDLER’S FIRST NAME
TELEPHONE
EMAIL
SERVICE ANIMAL USER’S SURNAME
(if different from Handler)
SERVICE ANIMAL USER’S FIRST NAME
(if different from Handler)
TELEPHONE
ANIMAL’S NAME
ANIMAL’S TYPE
BREED
WEIGHT (KG)
HEIGHT (CM)
WIDTH (CM)
(from shoulder to shoulder)
ACF5018D-UA (2021-02)
Please confirm that you agree to each of the following statements:
CONFIRMATION CHECKLIST:
Animal Health:
(____________________) is vaccinated for rabies.
Date of last vaccination:
Date vaccination expires in the dog:
To my knowledge, (____________________) does not have fleas or ticks or a disease that
would endanger people or other animals.
VETERINARIAN’S NAME (Signature not required)
TELEPHONE
Animal Training and Behaviour:
(____________________) has been trained to do work or perform tasks to assist me with my disability.
(____________________) 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 also does not urinate or defecate on the aircraft or in the gate area.
I confirm my animal is trained not to relieve itself in a non-indicated area and that it will not need to relieve
itself if flight is scheduled to take 8 hours or more.
I understand that if (
____________________) shows that it has not been properly trained to behave in public,
then the airline may treat (__________________) as a pet by charging a pet fee and requiring
(
____________________) to be transported in a pet carrier.
To the best of my knowledge, (
____________________) has not behaved aggressively or caused serious
injury to another person/dog. If you cannot check the box above, please explain.
NAME OF ANIMAL TRAINER OR TRAINING ORGANIZATION
TELEPHONE
Other Assurance:
I understand that (____________________) must be harnessed, leashed, or tethered at all times in the airport
and on the aircraft.
I understand that if (
____________________) 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.
By signing this form, I confirm that all the information I have provided is complete, true,
and accurate to the best of my knowledge.
SIGNATURE OF SERVICE ANIMAL USER / HANDLER
DATE (YYYY-MM-DD)
SUBMISSION OF THIS FORM INDICATES CONSENT WITH AIR CANADA’S PRIVACY POLICY.
Other documentation may be required for travel entering or exiting an international destination.
CLEAR FORM
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SERVICE ANIMAL FORM MEDICAL DEPARTMENT

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Completed 23 December 2021

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