EmailMeForm
ESA - REGISTRATION 2023/2024
How Did You Find Us?
*
Search Google
Search - Bing
Search - Yahoo
Facebook Page
Twitter
Instagram
Dog Groomers
Veterinarian
Friend
Mental Health Org
Health Org
GP - Doctor
Council
University/College
Other
Emotional Support Animal Registration - PLEASE TYPE IN ALL CAPITALS
Animal Type:
*
Please select
Dog
Cat
Rabbit
Animal's First Name:
*
22 characters
Animal's Breed:
*
22 Characters Only
Animal's Sex Assigned at Birth
*
Female
Male
"Sex assigned at birth" refers to the label a Veterinarian gives when the animal is born.
Animal's DOB:
*
MM
/
DD
/
YYYY
correct DOB
Animal's Photo For ID Card:
DO NOT SEND A CROPPED PHOTO - IT MUST BE IN FOCUS, BRIGHT LIGHT, CLOSE TO ANIMAL'S FACE & HIGH QUALITY PHOTO
*
if it is not following the instructions above the registration will be rejected
Flag Preference on the ESA card:
UK Only
+ England
+ Northern Ireland
+ Scotland
+ Wales
select one
Does Your Animal Have Any Training?:
*
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 Address :
*
EXAMPLE:
Flat 1
122 Doggy Street
Catztown
Essex
POSTCODE
*
EXAMPLE - SW58SD
Name of Parent or Guardian if ESA Owner is under 16 years of age
First
Last
Authorization of Parent or Guardian as the ESA Handler is under 16
I Authorize this process for the person under 16 years of age under my care
ESA Handler (the human who the ESA is for)
Name (1st & last):
*
22 Characters Only
- human who the ESA is for
Date of Birth:
*
MM
/
DD
/
YYYY
correct DOB
Sex Assigned at Birth
Male
Female
"Sex assigned at birth" refers to the label a medical professional gives to a baby when it is born - male or female.
Phone (cell preferred):
*
Email
*
Confirm
DUE TO LIMITED ACCESS TO MEDICAL PROFESSIONALS THIS LETTER MUST BE SENT TO US WITHIN 8 WEEKS.
Doctors/Mental Health Professional Information
*
I will get within 8 weeks
I have a Letter from a Doctor or Mentals Health Professional
Can You Produce the Letter if Required?
*
I will produce this letter within 8 weeks
I can produce this letter if asked by ESA UK
UPLOAD LETTER
MEDICAL PROFESSIONALS DETAILS
Name
Phone Number
Address
Date of Letter or Today's Date
DD
/
MM
/
YYYY
Contact Email
if you do not have this type n/a
Confirm
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 you use "Sex assigned at birth" which refers to the label a medical professional or Veterinarian gives to a baby or animal when it is born - male or female, and I release, indemnify, and hold harmless ESAUK, ESAORGUK, and their Employees, Officers, Directors, Agents, or Contractors from any and all damages or personal injury for the use of these terms.
Refunds can be completed by sending all items back using our refund process within 20 days.
I understand this is not to get my pet into places it is for my ongoing medical treatment for my hidden disability.
I also note that currently ESAs do not have the same rights as Service Animals or trained Assistance Animals & I can be refused entry into any business under the current Health Laws.
*
Clear
ESAUK - ONE YEAR
*
ESA REGISTRATION
YOUR CURRENT POSTAL / MAILING ADDRESS
WE DO NOT USE THE PAYPAL ADDRESS FOR DELIVERY - WE ONLY USE THIS POSTAL ADDRESS BELOW
CAPITALS PLEASE
POSTAL ADDRESS
*
PLEASE ADD YOUR MAILING ADDRESS AS IF YOUR LOOKING AT THE ENVELOPE
POSTCODE
*
EXAMPLE : SW67DF
COUNTRY:
Total
£50.00
