ONLINE REGISTRATION FORM!

 


D.I.A.L. S.T.A.R.T., Inc.

Service Animal Rights

Discrimination is Against the Law.  D.I.A.L. S.T.A.R.T., Inc. is a registered 501c3 non profit organization in good standing that advocates, educates and promotes the rights of the disabled, elderly and the service, therapy and companion animals who serve them world wide.

For more information: Phone: (310) 466-9696.

 

Official Assistance Animal Affidavit
Name of Disabled:  
Address:
City:  
State: 
Zip : 
Home Phone#:  
Work : 
Email :  
Service Animal Information
Species:  
Breed: 
Sex: 
Age/DOB
Color: 
Date placed in service:

    
I hereby declare I fully understand that any person who knowingly and fraudulently represents himself or herself, through verbal or written notice to be the owner or trainer of any animal licensed as, to be qualified as, or identified as a guide, signal, or service animal is guilty of a misdemeanor under the Civil Code and Penal Code and may be punished by imprisonment in a county jail and may incur a fine, or incur both imprisonment and fine. I verify that I am disabled under the law and my animal is qualified per the requirements of the law.