EmailMeForm
How Did You Find Us?
*
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Dog Groomers
Veterinarian
Friend
Newspaper
Doctor
Mental Health Org
Health Org
GP - Doctor
Council
Other
Emotional Support Animal Registration
Animal Type:
*
Please select
Dog
Cat
Rabbit
Animal's First Name:
*
Animal's Breed:
*
Animal's Weight:
Animal's Height:
Animal's Length:
Animal's Chip Number:
Pet Passport?:
*
Yes
No
Animal's Gender:
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Female
Male
Animal's DOB:
*
MM
/
DD
/
YYYY
Upload Animal's Photo For ID Card:
(DO NOT SEND A CROPPED PHOTO - IT MUST BE IN FOCUS, BRIGHT LIGHT, CLOSE TO FACE)
*
select photo and upload with form - make sure its like a passport photo of your animal
Flag Preference:
UK Only
+ England
+ Northern Ireland
+ Scotland
+ Wales
select one
Does Your Animal Have Any Training?:
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None
Home Training
Professional Training
Other
If Trained What Level?
Upload Training Certificate
if your dog is professionally trained please upload the training certificate
Animal's Address:
*
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Antigua and Barbuda
Aruba
Bahamas
Barbados
Belize
Canada
Cayman Islands
Cook Islands
Costa Rica
Cuba
Dominica
Dominican Republic
El Salvador
Grenada
Guatemala
Haiti
Honduras
Jamaica
Mexico
Netherlands Antilles
Nicaragua
Panama
Puerto Rico
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Trinidad and Tobago
United States
Argentina
Bolivia
Brazil
Chile
Colombia
Ecuador
Guyana
Paraguay
Peru
Suriname
Uruguay
Venezuela
Albania
Andorra
Armenia
Austria
Azerbaijan
Belarus
Belgium
Bosnia and Herzegovina
Bulgaria
Croatia
Cyprus
Czech Republic
Denmark
Estonia
Faroe Islands
Finland
France
Georgia
Germany
Greece
Hungary
Iceland
Ireland
Italy
Kosovo
Latvia
Liechtenstein
Lithuania
Luxembourg
Macedonia
Malta
Moldova
Monaco
Montenegro
Netherlands
Norway
Poland
Portugal
Romania
San Marino
Serbia
Slovakia
Slovenia
Spain
Sweden
Switzerland
Ukraine
United Kingdom
Vatican City
Afghanistan
Bahrain
Bangladesh
Bhutan
Brunei Darussalam
Myanmar
Cambodia
China
East Timor
Hong Kong
India
Indonesia
Iran
Iraq
Israel
Japan
Jordan
Kazakhstan
North Korea
South Korea
Kuwait
Kyrgyzstan
Laos
Lebanon
Malaysia
Maldives
Mongolia
Nepal
Oman
Pakistan
Palestine
Philippines
Qatar
Russia
Saudi Arabia
Singapore
Sri Lanka
Syria
Taiwan
Tajikistan
Thailand
Turkey
Turkmenistan
United Arab Emirates
Uzbekistan
Vietnam
Yemen
Australia
Fiji
Kiribati
Marshall Islands
Micronesia
Nauru
New Zealand
Palau
Papua New Guinea
Samoa
Solomon Islands
Tonga
Tuvalu
Vanuatu
Algeria
Angola
Benin
Botswana
Burkina Faso
Burundi
Cameroon
Cape Verde
Central African Republic
Chad
Comoros
Democratic Republic of the Congo
Republic of the Congo
Djibouti
Egypt
Equatorial Guinea
Eritrea
Ethiopia
Gabon
Gambia
Ghana
Gibraltar
Guinea
Guinea-Bissau
Cote d'Ivoire
Kenya
Lesotho
Liberia
Libya
Madagascar
Malawi
Mali
Mauritania
Mauritius
Morocco
Mozambique
Namibia
Niger
Nigeria
Rwanda
Sao Tome and Principe
Senegal
Seychelles
Sierra Leone
Somalia
South Africa
Sudan
Swaziland
United Republic of Tanzania
Togo
Tunisia
Uganda
Zambia
Zimbabwe
Country / Region
Animal's Instagram Address:
Name of Parent or Guardian if ESA Owner is under 16 years of age
First
Last
Authorization of Parent or Guardian as the ESA Owner under 16
I Authorize this process for the person under 16 years of age under my care
ESA Handler
First Name:
*
Last Name:
*
Date of Birth:
*
MM
/
DD
/
YYYY
Gender:
*
Male
Female
Phone (cell preferred):
*
Email
*
Confirm
DUE TO LIMITED ACCESS TO MEDICAL PROFESSIONALS BECAUSE OF THE CORONAVIRUS A LETTER CAN BE SENT AS SOON AS YOU GET AN APPOINTMENT
Doctors/Mental Health Professional Information
*
I will get later after Coronavirus over
I have a Letter from a Doctor or Mentals Health Professional
Can You Produce the Letter if Required?
*
I will produce this letter after the Coronavirus
I can produce this letter if asked by ESA UK
Doctor's or Mentals Health Professional's Name
Address of Doctor or Mental Health Professional
Phone Number of Doctor or Mental Health Professional
Contact Email of Doctor or Mental Health Professional
if you do not have this type n/a
Date of Letter or Today's Date
*
DD
/
MM
/
YYYY
Please review your information to make sure everything is as accurate as possible.
I hereby certify that information I have provided is accurate and correct to the best of my knowledge.
By inputting my signature, I confirm that to the best of knowledge, the information I have provided to ESAUK is accurate.
I also confirm that I understand my input information will be kept for ONLY 13 months & then deleted off the system except I agree to keep my name and email address after this period if I do not re-register.
I agree for the photo I have submitted to be used on Instagram with no name or location.
I understand that the behavior of animals cannot be guaranteed. I also understand that the behavior of domestic animals is sometimes unpredictable and that some domestic animals are capable of inflicting serious personal injury or death, as well as extensive property damage. Knowing the risks I agree to assume ALL those risks including, but not limited to; assuming the financial responsibility of any possible litigation arising from any incident in which I may be involved. I release, indemnify, and hold harmless ESAUK, ESAORGUK, and their Employees, Officers, Directors, Agents, or Contractors from any and all damages or personal injury. Any incident involving myself, the location, or those pets or actions of other participants and spectators will be my sole responsibility and I assume all financial liability and will also assume all and any financial costs associated with my actions.
I understand this is not to get my pet into places it is for my ongoing medical treatment.
NO REFUND as the documentation is printed and mailed to you by two outside companies & digital copies are also sent to you.
I also note that currently ESAs do not have the same rights as Service Animals & can be refused entry into any business.
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Clear
ESAUK - ONE YEAR
*
ESA REGISTRATION
THIS SECTION HELPS ADJUST THIS FORM FOR ANY ISSUES
DEVICE USED
*
PHONE
TABLET
PC/COMPUTER/LAPTOP
OTHER
DEVICE OS
*
ANDROID
APPLE
WINDOWS
OTHER
IF PHONE USED
IPHONE
SAMSUNG
NOKIA
VIVO
ONEPLUS
HUAWEI
HONOR
GOOGLE
MOTOROLA
SONY
XIAOMI
OTHER
IF TABLET USED
IPAD
ANDROID
SURFACE
OTHER
BROWSER USED
*
SAFARI
CHROME
FIREFOX
IE
EDGE
OPERA
OTHER
POSTAL / MAILING ADDRESS - CAPITALS PLEASE
FOR THE ESA CARD, CERTIFICATE & CERTIFICATION LETTER
NAME / TO
*
STREET ADDRESS
*
ADDRESS LINE 2
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CITY
*
COUNTY
*
POSTCODE
*
COUNTRY:
Total
£50.00