• Service Dog Flight Request Application

    Service Dog Flight Request Application

    For Service Dog Training and Retrieval Flights

  • Welcome to the Miracle Flights Service Dog Training and Retrieval Flight Request Application Form. Information collected will be used by our staff to review your request, and if approved, coordinate travel on your behalf. All data provided will be kept in strict confidence and only used for this purpose. 

    Before completing our application, please answer the questions below to see if you qualify for our program services. 

    Miracle Flights’ Service Dog Program is available exclusively to financially and medically eligible individuals traveling within the United States to retrieve and/or complete training with a qualified service dog. Transportation is provided on U.S. commercial flights for approved applicants who meet Miracle Flights’ financial and medical eligibility guidelines.


    While Miracle Flights’ primary mission is providing free commercial air travel within the United States for children who qualify based on financial need, connecting them with board-certified medical providers and accredited treatment facilities for life-changing medical care, the Service Dog Program supports qualified individuals whose travel is directly related to obtaining or training with an ADA-qualified service dog.


    Under the Americans with Disabilities Act (ADA), a service animal is defined as a dog individually trained to perform specific tasks directly related to a person’s disability. Dogs whose sole function is to provide comfort, companionship, or emotional support do not qualify as service animals under the ADA and are therefore not eligible for this program.

  • Are you requesting a flight for one of the allowed service dog-related reasons?*
  • Does the patient/applicant and all accompanying passengers have the required identification and/or documentation to get through TSA and travel on a commercial airplane?*
  • Can the patient/applicant and all accompanying passengers safely travel on a commercial airplane?*
  • Do you currently live in the U.S. AND do you have a confirmed service dog retrieval/training scheduled requiring domestic U.S. air travel? (We do not provide international travel in or out of the U.S.)*
  • Is your requested departure flight date at least 14 days away?*
  • What type(s) of government assistance are you currently receiving? Please select all that apply. You will need to upload proof of government assistance (dated within the last 90 days) at the end of this application. If you are not currently receiving government assistance, please check “None”.*
  • Do you have your IRS 1040 documents from last year to upload on this application as proof of household income and household size? (From January 1-April 15th each year, we will also accept W-2 forms for all employment related income.)*

  • Wonderful News! 

    Based on your preliminary answers, you are eligible for our program services. Click the NEXT button to complete your application.

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  • We're Sorry

    Unfortunately we cannot help at this time. We only provide flights for pediatric patients (age 17 and under). If you think you have received this message in error, please email apphelp@miracleflights.org. 

  • We're Sorry

    Unfortunately we cannot help at this time. We only provide commercial flights. All of our passengers must be able to safely board and have the required identification to travel on commercial airplanes in accordance with guidlines set forth by airports, airlines, FAA, and the TSA.

    For air ambulance services we recommend contacting the following non-profits:

    Wings of Hope: wingsofhope.ngo

    Grace on Wings: graceonwings.org

    Air Care Alliance: aircarealliance.org

    If you think you have received this message in error, please email apphelp@miracleflights.org. 

  • We're Sorry

    Unfortunately we cannot help at this time. Miracle Flights only provides domestic U.S. flights for medical travel. We are not providing any new international flights at this time. All medical and service dog retrieval/training appointments must be scheduled prior to applying for Miracle Flights.

    Please visit us again once your have your medical appointment booked. If you think you have received this message in error, please email apphelp@miracleflights.org. 

  • We're Sorry

    Unfortunately we cannot help at this time. We require at least 14 days to process and coordinate air travel for all applicants. 

     

    If you think you have received this message in error, please email apphelp@miracleflights.org. 

  • We're Sorry

    Unfortunately we cannot help at this time. With your household size, your gross household income exceeds our eligibility requirement.

     

     

    If you think you have received this message in error, please email apphelp@miracleflights.org. 

  • We're Sorry

    Unfortunately we cannot help at this time. Our service dog program is intended exclusively for individuals traveling to retrieve or train a service dog. According to the ADA (Americans with Disabilities Act), a service animal is a dog trained to perform tasks directly related to a person's disability.


    If you believe you need a service dog but have not yet taken the necessary steps to qualify for one, we recommend contacting organizations that specialize in service dog training and certification. For example:

    • Assistance Dogs International (ADI): www.assistancedogsinternational.org
    • Canine Companions for Independence: www.canine.org
    • The National Service Animal Registry: www.nsarco.com

    These organizations can guide you in determining if a service dog may be appropriate for your specific circumstances and disability. If so, they may be able to assist you in the process of obtaining a service dog.
     

    If you think you have received this message in error, please email apphelp@miracleflights.org. 

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  • Information needed to proceed with application:

    • Scheduled Service Dog Retrieval or Training Appointment and Release Date(s) -- Your treatment site must be able to verify your medical appointment date(s)
    • Requested Flight Dates (within 3 days of service dog appointment and release dates)
    • Passenger Information (full names, date of birth, address)
    • Birth Certificate For All Child Patients PDF/JPG/PNG -- Upload required
    • Household Income and/or Government Assistance Certification PDF/JPG/PNG  -- Upload required. First two pages of latest 1040 tax return documents or proof of current government assistance program are required for all applicants (dated within the last 90 days). From January 1-April 15th each year, we will also accept W-2 forms for all employment related income. When not required to file a tax return SSI/SSDI statements and/or paystubs may be submitted in lieu of 1040 tax documents for all income earners responsible for the child patient in the household.

     

    Make sure you have the above information ready BEFORE moving forward with your application. Total time to complete is less than 15 minutes.

     

    If your departure date is less than 14 days away or if you are requesting travel from outside the US - DO NOT PROCEED -  as you will not be eligible for services at this time. 

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  • Flight Request Details

  • Our dedicated Flight Department coordinates hundreds of flights each month for families across the U.S. The information provided below will help our team find the best flights based on your departure/arrival city and appointment day/time. Please include alternative airports (if applicable) to allow us to serve you in the most time/cost effective way possible.

    All departure and return flight dates must be booked within 3 days of the scheduled service dog appointment date and treatment site release date.

  • If approved, will this be your first time using Miracle Flights?*

  • Welcome Back! We're excited to help you and your family again.

  • Welcome to The Miracle Flights Family!

  • Is your requested departure date at least 14 days away?*
  • What Type of Travel Is This?*
  • Scheduled Medical Appointment or Service Dog Retrieval/Training Date*
     / /
    2 digit month, 2 digit day, 4 digit year
  • IT - Scheduled Medical Appointment or Service Dog Retrieval/Training Date*
     / /
    2 digit month, 2 digit day, 4 digit year

  • STOP - READ CAREFULLY

     

    You've indicated that your requested departure date is less than 14 days away.

     

    Unfortunately we cannot help at this time. We require at least 14 days to process and coordinate air travel for all applicants. 

     

    If you think you have received this message in error, please email apphelp@miracleflights.org. 

  • Departure Date*
     / /
    2 digit month, 2 digit day, 4 digit year
  • IT - Departure Date*
     / /
    2 digit month, 2 digit day, 4 digit year
  • Return Date*
     / /
    2 digit month, 2 digit day, 4 digit year
  • IT - Return Date*
     / /
    2 digit month, 2 digit day, 4 digit year

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  • Service Dog Patient Information

    Please fill out all required fields for the service dog patient seeking service dog retrieval and/or training. The contact information listed should be the primary contact information for the family. Please confirm all details are ACCURATE as this information will be used to book your flight itinerary.
  • Date of Birth*
     / /
    2 digit month, 2 digit day, 4 digit year
  • Gender*
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Is your service dog retrieval or training covered by your medical insurance?*
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Oxygen, service dog, and wheelchair information is requested to notify the airlines.
    Miracle Flights does NOT provide oxygen, service dogs, or wheelchairs for passengers.
  • Oxygen Required*
  • Will you be flying with a service dog?*
  • Wheelchair Required*
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  • Patient Information Demographics

  • The below information will be used in reporting demographic statistics to various foundations and government agencies. It will not be used to determine who is eligible to receive our services. In the case where a child (age 17 and under) is being transported -- the education, marital status, and employment questions apply to the parent or guardian completing this application.

  • Patient Ethnicity (Select all that apply)*
  • Highest level of education completed (by adult patient OR parent/guardian of child patient filling out this form)*
  • Marital Status (of adult patient OR parent/guardian of child patient filling out this form)*
  • Employment Status (of adult patient OR parent/guardian of child patient filling out this form)
  • Military Service (of adult patient OR parent/guardian of child patient)*
  • Military Member (of adult patient OR parent/guardian of child patient)*
  • How did you hear about us?*

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  • Patient Waiver of Liability

    To be completed by parent/legal guardian of child service dog patient (17 and under) or the adult service dog patient.

  • In consideration of their providing financial assistance for air travel or items or supplies at no cost and solely for my benefit, I, the undersigned, do hereby release the nonprofit Miracle Flights and commercial airlines fully and without reservation from any and all claims whatsoever of culpability, responsibility, fault and liability for any inadvertent and/or accidental occurrence which may result in personal injury or property damage or other effect, during all times that I am a passenger in the act of boarding, while aboard, or in the act of deplaning an aircraft provided by said Miracle Flights and commercial airlines:

  • Photo/Video Release*
  • Relationship to Patient*

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  • Will the patient require a second passenger?*

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  • Passenger 2 - Airline Ticket Required Information

    Please use exact names as they appear on government identification. If service dog patient is 17 or under, PASSENGER 2 MUST BE THE TRAVELING PATIENT'S PARENT OR LEGAL GUARDIAN AS DISPLAYED ON THE PATIENT'S BIRTH CERTIFICATE OR OTHER LEGAL DOCUMENTATION. If patient is 18 or over, PASSENGER 2 MUST BE A MEDICALLY NECESSARY COMPANION/CHAPERONE. Please confirm all details are ACCURATE as this information will be used to book your flight itinerary.
  • Date of Birth*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Gender*
  • Format: (000) 000-0000.
  • Passenger 2 - Address is the same as the patient?*
  • Passenger 2 Waiver of Responsibility*

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  • Passenger 2 - Waiver of Liability

    To be completed by accompanying passenger (18 and over)

  • In consideration of their providing financial assistance for air travel or items or supplies at no cost and solely for my benefit, I, the undersigned, do hereby release the nonprofit Miracle Flights and commercial airlines fully and without reservation from any and all claims whatsoever of culpability, responsibility, fault and liability for any inadvertent and/or accidental occurrence which may result in personal injury or property damage or other effect, during all times that I am a passenger in the act of boarding, while aboard, or in the act of deplaning an aircraft provided by said Miracle Flights and commercial airlines:

  • Photo/Video Release*

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  • Income Certification

    Fraudulent statements or intentional misrepresentation shall be considered sufficient cause for denial of service.
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  • Flight Request Acknowledgements

    Please read carefully and sign.

  • Miracle Flights reserves the right to alter policy in exceptional circumstances.

    I am aware that free commercial flights arranged by Miracle Flights are charitable in nature and therefore may occur during off-peak hours and may include stopovers and/or plane changes. I also understand that flights can only be arranged according to Miracle Flights’ guidelines, as follows:

    • Service Dog Retrieval and/or Training: Miracle Flights will consider requests to fly the service dog patient (regardless of age) and UP TO one additional parent/legal guardian/family member (up to 2 total passengers).

    I am aware that any other accompanying passengers are responsible for their own flight arrangements and understand that these flight arrangements may or may not be compatible with the flight arranged for me by Miracle Flights.

    Penalty for false fraudulent statement: U.S.C. Title 18, Sec. 1001 provides: “whoever, in any matter within the jurisdiction of any department or agency of the United States knowingly and willfully falsifies, or makes false, fictitious or fraudulent statements or
    representation or makes or uses any false writing or documentation knowing the same to contain any false, fictitious or fraudulent statement or entry, shall be fined not more than $10,000 or imprisoned not more than five years, or both.”

    By signing below, I acknowledge that I have read and understand the information above.

  • Relationship to Patient*

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  • Congratulations, you're almost done!

    If you need to go back and review/edit anything, do it now. If the above information is accurate, you're ready to submit the application.

    We look forward to serving you soon. 

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