General Statement:  Acknowledgement and Release of Information Consent Form and  Responsibility of an Individual with an ESA - Acknowledgement.  Having read the aforementioned guidelines, I acknowledge that I understand them, accept them, and agree to abide by them.  I understand that if I fail to meet the requirements set forth in this policy, MECA&D has the right to remove the emotional support animal.  I furthermore provide my written consent that the Disability Services Coordinator may disclose to others the presence of the ESA.  I further recognize that my ESA may be noticed by others in the residence hall environment (visitors, other residents) and agree that staff may acknowledge the presence of the animal and explain that the animal is permitted in some circumstances for persons with disabilities. I have fully read and agree to the Responsibility of an Individual with an ESA - Acknowledgement. By submitting this form I have agreed to abide by these responsibilities.