EmailMe Form - ESAEU

ESA REGISTRATION NUMBER - *

ESA'S REGISTRATION NUMBER - 12 NUMBERS

ESA NAME - *

ESA'S FIRST NAME - 22 CHARACTERS

ESA PHOTO - *

IF YOU WANT A NEW PHOTO PLEASE UPLOAD

ESA ID CARD FLAG - *

ANY CHANGES YOU WANT -

ANY CHANGES - EXAMPLE NAME, ADDRESS, ETC.

HANDLER'S NAME - *

First Last

HANDLER'S NAME 22 CHARACTERS ONLY

MAILING ADDRESS - *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code

YOUR EMAIL - *

ADD YOUR EMAIL ADDRESS & CONFIRM IT

Confirm

PLEASE VERIFY THAT *

I am still receiving ongoing treatment for my mental health

My medical details & letter are still the same & available on request

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 ESAEU 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 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 ESAEU, ESAORGEU, 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 also note that currently ESAs do not have the same rights as Service Animals & can be refused entry into any business. *

YES