Management Plan for the Care of the Service Animal
This information is being collected pursuant to the provisions of the Municipal Freedom of Information and Protection of Privacy Act (MFIPPA) and under the Authority of the Education Act, and will be used by Special Education to create a management plan for the Service Animal in schools. Questions about this collection should be directed to the Superintendent of Education – Special Education, Niagara Catholic District School Board,427 Rice Road, Welland, Ontario L3C 7C1, 905-735-0240.
Student Name
[ ] M
[ ]
F
Date mm/dd/yyyy
Parent/Guardian
Home Phone
Address
Work Phone
City/Postal Code
Date of Birth mm/dd/yyyy
School
Teacher
Grade Level
OEN #
It is the responsibility of the parent/guardian to be financially responsible for any costs incurred for the care of the service animal including but not limited to: veterinary care, food, grooming, harness, crate and/or mat, ensure that the service animal is groomed, clean, and in good health prior to entering the school building or school-related activities and arrange for the personal care and physical needs of the service animal, including bio-breaks and the removal and disposal of waste in a safe and environmentally friendly manner.
Name of Handler: ___________________________________________________
Name of Service Animal: ______________________________________________
The service animal will follow the student’s daily schedule:
1.
In the case of a fire, lockdown (drills), inclement weather etc., the service animal will follow the school emergency procedures for staff and students.
2.
The parent/guardian will be contacted and required to pick up the service animal when there is a health or safety concern, or the behaviour of the service animal is distracting, disruptive or aggressive, including making noise, failing to follow commands, growling or nipping.
Alternate contact, if the parent/guardian is not available
