SMC Service/ Emotional Support Animal Consent & Release Form

Please complete this form for SMC's Accessibility Resources office.

Student's Name Student's Name * First Last
Student's Cell Phone Number Student's Cell Phone Number * - ### - ### ####
Student's Email *
SMC ID #
Today's Date Today's Date * / MM / DD YYYY
Service/ Emotional Support Animal Consent & Release Form

Please read and indicate your consent by typing your full name in the section below.
I have read and understand the Spartanburg Methodist College Service and Emotional Support Animal policy, and I agree to abide by its requirements. I understand that if I fail to meet the requirements set forth in the policy, Spartanburg Methodist College has the right to remove my service/ emotional support animal, and I will nonetheless be required to fulfill my housing, academic, and other obligations as applicable.

I give permission to SMC's Accessibility Resources office and the SMC Office of Community Life to disclose to others impacted by the presence of my service/ emotional support animal in campus housing (e.g., Community Life staff, potential/actual roommates, suitemates, or neighbors) that I will be living with an animal as an accommodation. I understand that (1) the information shared will be limited to notice about the animal's presence and will NOT include information about my disability or the specific reason that the animal is required and that (2) this information will be shared with the intent of preparing for the presence of the animal and/or resolving any potential issues associated with the presence of the animal. I will not hold Spartanburg Methodist College liable for disclosing such information.

I recognize that the presence of an service/ emotional support animal may be noticed by others visiting or residing in campus housing and agree that staff may acknowledge the presence of the animal and may inform third parties that under certain circumstances, animals are permitted to accompany persons with disabilities in campus housing.

By typing my full name, I understand and consent to the above information. *