Service Dog and Emotional Support Animal Roommate Agreement Form

Service Dog and Emotional Support Animal Roommate Agreement Form

Navarro College Housing Department
This form is to inform you that one of your roommates has been approved for a Service / Emotional Support animal. This approved animal will be residing in your shared assigned living space in.

A Navarro College student who resides with the owner of a service / emotional support animal must complete the Roommate Agreement Form. The owner is responsible for sending the form to all students living in the same space.
Roommate Rights and Responsibilities

I am fully aware that my roommate is requesting to bring a service / emotional support animal to reside in our shared residence on campus. If this request is approved by all appropriate college entities, I understand and agree to the following:
Agreement and Consent

Below confirms my receipt of this policy and acknowledges my consent for my roommate/suitemate to have an Service/Emotional Support Animal in their living space.
I agree to reside with the resident with a service/emotional support animal.I do not agree to reside with the resident with a service/emotional support animal.
I consent to allowing the service/emotional support animal in the common living space.I do not consent allowing the service/emotional support animal in the common living space.
Name of Roommate Who is the Owner of Service/Emotional Support Animal.*

First NameLast Name
DogCatOther
Semester and Year*
Your Name*

First NameLast Name
Your Navarro College Student Identification Number*
Your Student Email*
Your Phone Number*
Format: (000) 000-0000.
Your Residence Hall Building Number*
Your Residence Hall Room Number*
Electronic Signature Agreement

By clicking the "Submit" button, you are signing this document electronically. You acknowledge and understand that you may complete the Service Dog and Emotional Support Animal Grievance Form and submit it to the Navarro College Housing Department if the animal displays disruptive and/or threatening behavior. You acknowledge and understand that you will not be held responsible for any damages or cleaning costs associated with your roommate's/suitemate's animal.
Your Signature*

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Date of Agreement*

MonthDayYear
Date will be captured on form submission.
Should be Empty:

Service Dog and Emotional Support Animal Roommate Agreement Form

Roommate Rights and Responsibilities

Agreement and Consent

Electronic Signature Agreement