Pepperdine University
Office of Student Accessibility
Approved Service Animal Agreement
The owner of an assistance animal must:
❏ Comply with any and all county, state, or federal licensing requirements, as appropriate
for the animal, with copy of licenses submitted to OSA
❏ Follow their veterinarian’s care recommendations and vaccinations for the animal, with
copy of health record submitted to OSA
❏ Be financially responsible for any bodily injury or property damage caused by the
animal, in addition to the cost of extra cleaning due to the animal
❏ Control the animal by keeping the animal leashed when outside or within the owner’s
designated suite at all other times
❏ Cleanup and appropriately dispose of the animal’s waste
❏ Have written agreement from any roommates or suitemates that consent to the
presence of the animal in the suite, with a copy of the agreement submitted to OSA
Failure to adhere to this agreement is considered a violation of our residential student policy
and could result in a judicial hearing.
Service Animal Information:
_____________________ _____________________ ___________________________
Name Type (dog, cat, etc.) Breed/Color
_____________________ _____________________ Neutered? Y N
Age/Weight LA County License # Gender? M F
Student Name Signature Date
OSA Staff Name Signature Date
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