RBC Service Animal Registration

Registrant Information

Student ID*

This is your Richard Bland College R-Number

Name*

First Name

Initial (optional)

Last Name

Suffix (optional)

RBC Email*

Please use your Richard Bland College email address

Phone Number*

Please enter a phone number where you can be easily reached

Animal Type*

Dog Miniature Horse

Which type of official service animal are you registering?

Disability Related?*

Yes No

Is this animal required because of a disability?

Animal Name*

(64 max characters) Let us know your animal's name in case we have to interact

Color/Description*

(250 max characters) Give a brief description of the animal including color and any other distinguishing characteristics

Service Work*

(250 max characters) Give a brief description of the work this animal been trained to perform

Service Animal Photo*

No File Chosen

File uploads may not work on some mobile devices.

Upload a photo of your service animal for our records (jpg, jpeg, gif, png, tif, pdf). Max file size is 1MB.