6:120-E2 Parent/Guardian Request for Service Animal within the School Setting

Date: _______________

Parent/Guardian Completing this Form: _______________________________

Child’s Name: ________________________________

School: _____________________________

The Board of Education recognizes that there are many occasions when animals are present on District property and many reasons for those animals’ presence. Employees, students, parents, vendors, and other members of the public may be accompanied at school by a service animal in accordance with Federal and State law. The following guidelines are intended for use by Building Principals to:

1. Ensure that the legitimate safety interests of staff and students are met,

2. Inform their individual building staff of these guidelines when service animals are present in their individual buildings, and

3. Request that staff members inform the Building Principal if they observe a service animal that is not meeting any of the listed guidelines.

These guidelines are not based on speculation, stereotypes, or generalizations about students with disabilities. Each guideline includes an explanation based upon State and federal law with legal citations and resources that provide further information.

1) Is the service animal individually trained to perform task for the benefit of your child?

2) Does the service animal have a current rabies vaccination and tag?

3) Does the service animal have a handler?

4) Is the service animal housebroken?

5) What tasks will the service animal complete that are directly related to your child’s disability?

6) What does the teacher need to know in order for the service animal to assist your child in the classroom?

7) Is there a list of commands or gestures for the animal? If yes, please attach the list to this document.

8) What type of training needs to be provided to the staff working with your child? (Please be specific in the outcome of the training, number of hours, and recommended location.)

9) What is the role of the service animal’s handler in the school setting?

10) At what times of the day does the service animal need to be under the guidance of a handler? What is the expectation of the therapy/service dog when the student is in settings other than the classroom? Cafeteria: Recess: Gymnasium/Physical Education Class: Field Trips/School Assemblies

11) Please specify the daily care plan of the service animal. Specifically, when the dog needs to be fed, taken to the bathroom, or provided with a break.

12) How will the therapy/service dog be transported to and from the school setting?

Date Adopted:  02/18/2015