Name of Person Submitting Request::

Email Address of Person Submitting Request:  

Address:  

Daytime Phone #: Evening Phone#:  Reservation Number:  

1. I am a person with a disability/handicap as defined by one or more of the following: A physical or mental impairment that substantially limits one or more major life activities; or a record of having such an impairment; or is regarded as having such an impairment.:  

**I am not the person with a disability/handicap, but the following Guest, for whom I am the legal guardian or parent, has a disability as defined above::

Name:  

Relationship to you (e.g. child, parent):  

2. As a result of this disability/handicap, I am requesting the following reasonable accommodation for the Guest identified above: an exception to the Glass Casa rental property’s “no pets” policy, to allow the following animal to reside in the unit::  

3. This request for a reasonable accommodation is necessary so that the Guest has an equal opportunity to use and enjoy the Property which I (or the requesting party) currently lack because::   

Owners Name:   Reservation Number:  

Type of Animal:  Animals Name:  Breed:  

Color:  Selet Male or Female:  Weight in LBS:  

Height:  Date Animal Acquired: Animals License Number:

Type of Animal - 2: Animals Name - 2: Breed -2:

Color - 2: Selet Male or Female - 2: Weight in LBS - 2:

Height - 2: Date Animal Acquired - 2: Animals License Number - 2:  

Veterinarian:

PLEASE ATTACH: PHOTOGRAPH OF ANIMAL:

(2) COPY OF VETERINARIAN’S CERTIFICATION THAT ALL SHOTS AND INOCULATIONS ARE CURRENT AND DATE NEXT SHOTS/INOCULATIONS ARE DUE.:

Glass Casa, Inc.
Policy and Procedures: Assistance Animal Requests
Pets are not permitted in most Glass Casa, Inc. (“Glass Casa”) rental properties unless specifically authorized in advance. Assistance animals are not deemed to be pets for purposes of a “no pets” policy; however, a Guest who asserts a need to be accompanied by an assistance animal must request an accommodation for Glass Casa’s review. When the nature of the disability is not known or obvious, the Guest should provide reliable documentation for Glass Casa to assess the request.

An assistance animal is one which provides assistance, or performs tasks for the benefit of a person with a disability, or provides emotional support that alleviates one or more identified symptoms or effects of a person’s disability. Assistance animals perform many disability-related functions, including but not limited to, guiding individuals who are blind or have low vision, alerting individuals who are deaf or hard of hearing to sounds, providing protection or rescue assistance, pulling a wheelchair, fetching items, alerting persons to impending seizures, or providing emotional support to persons with disabilities who have a disability-related need for such support.1 Furthermore, while dogs are the most common type of assistance animal, other animals may be fairly categorized as assistance animals under applicable federal and state laws.

Please review the following policies and procedures regarding the submission of a request for a reasonable accommodation to be accompanied by an assistance animal during your visit:
1. Owners, tenants, guests, or invitees (“Guests”) who will be traveling with an assistance animal to a vacation property (“Property”) are advised to complete the enclosed Request for Reasonable Accommodation and Registration Form and return it to the address provided on the form, or otherwise notify Glass Casa of the request in writing. Please note, Glass Casa cannot provide a reasonable accommodation if a request for the accommodation is not submitted and received.2
2. If the disability for which the person requesting an assistance animal is not obvious, Glass Casa will require documentation from a licensed physician or mental health provider, including without limitation, a qualified psychiatrist, social worker, or other mental health professional (collectively referred to as “provider”), who should provide reliable documentation for Glass Casa to assess the request. The information provided by the provider may include the following:
a. The patient’s name;
b. Whether the provider has a professional relationship with the patient/client involving the provision of health care or disability-related services;
c. The type of animal for which the accommodation is sought;
d. The provider’s diagnosis of the person’s disability;
e. The provider’s opinion that the condition affects a major life activity; and/or,
f. The provider’s opinion that the emotional support animal has been prescribed for treatment purposes and is necessary to help alleviate symptoms associated with the person’s condition.
g. The date of the last consultation with the patient.
1 U.S. Department of Housing and Urban Development, Fair Housing and Equal Opportunity Notice No. 2013-01, Service Animals and Assistance Animals for People with Disabilities in Housing and HUD-Funded Programs, April 25, 2013
2 Joint Statement of The U.S. Department of Housing and Urban Development and The U.S. Department of Justice, Reasonable Accommodations Under the Fair Housing Act, May 17, 2004

3. Upon receipt of any requested information, Glass Casa shall have a reasonable period of time in which to review the request and determine if it provides sufficient detail for Glass Casa to determine whether the accommodation should be granted.

4. Should Glass Casa determine that further information is necessary, it shall advise the party requesting the accommodation and the documentation required for further evaluation of the request.

5. A request may be denied, or an assistance animal may be required to be removed even if initially approved, if:
a. the assistance animal in question poses a direct threat to the health or safety of others that cannot be reduced or eliminated by another reasonable accommodation;3 or,
b. the assistance animal would cause substantial physical damage to the property of others that cannot be reduced or eliminated by another reasonable accommodation; or,
c. the animal is not housebroken (i.e., trained so that, absent illness or accident, the animal controls its waste elimination).4

6. Furthermore, pursuant to guidelines issued by the U.S. Department of Housing and Urban Development and U.S. Department of Justice, an accommodation may be denied if:
a. is not made on behalf by or on behalf of a person with a disability;
b. if there is no disability-related need for the accommodation;
c. if providing the accommodation is not reasonable, i.e., if it would impose an undue financial and administrative burden on the housing provider or if it would fundamentally alter the nature of the provider’s operations.5
In the event that Glass Casa is unable to approve a requested accommodation, Glass Casa will engage in an interactive process and discuss with the Guest whether there are alternative accommodations that would effectively address the Guest’s disability-related needs.

7. In general, assistance animals are well-trained and well-behaved. However, in the event that an assistance animal causes damage beyond normal wear-and-tear, the Guest will be liable for the costs incurred associated with the damage. Please note, Glass Casa will hold the booking Guest liable for damages caused by an assistance animal, regardless of whether the booking Guest was the individual accompanied by the assistance animal.

8. In addition to federal guidelines, the State of Florida has enacted legislation which makes the knowing and willful misrepresentation of using a service animal and being qualified to use a service animal or as a trainer of a service animal punishable by law, including being guilty of a misdemeanor of the second degree, punishable as provided in Sec. 775.082, Fl. Stat., or 775.083, Fl. Stat. A person committing an offense of this nature must perform 30 hours of community service for an organization that serves individuals with disabilities, or for another entity or organization at the discretion of the court, to be completed in not more than 6 months.6

3 75 Fed. Reg. at 56194, 56268
4 28 C.F.R. §35.136; 28 C.F.R. §36.302(c)
5 Joint Statement of The U.S. Department of Housing and Urban Development and The U.S. Department of Justice, Reasonable Accommodations Under the Fair Housing Act, May 17, 2004
6 Sec. 413.08(9), Fl. Stat.

Leave this empty:

Your legal name

Your email address

Please Confirm full name and signature.

Change fonts

• Draw Signature
  
• Type In Signature
  

Draw your signature with your mouse, tablet or smartphone Clear

I agree that I am and I agree this is a legal representation of my signature for all purposes just the same as a pen-and-paper signature

Insert Signature

I agree that I am and I understand this is a legal representation of my signature

Adopt & Sign

Signature Certificate

Document name: Animal Assistance Signature Form

Unique Document ID: 81acecc66d9074a8a2503e33585bfb9329bf9a5d

Build. Track. Sign Contracts.

Timestamp	Audit
September 28, 2021 10:11 am CDT	Animal Assistance Signature Form Uploaded by Randy Bacik - randy@glasscasa.com IP 70.165.31.44, 127.0.0.1, 198.71.237.41, 0.0.0.0

This audit trail report provides a detailed record of the online activity and events recorded for this document.

https://glasscasamanagement.com/

Audit Trail Serial# a03dbeca7a174ec98413b672dfc33ba0