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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