Contact Us

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Name
Phone *
Phone
Physical Address *
Physical Address


Baytown

We have a No Kill mission to save the lives of animals abandoned and/or placed in kill shelters. Through outreach, education, and service, we provide homeless cats and dogs with an opportunity to live their full life. 

Microchip Program Application

microchip program APPLICATION

The below application is for A free microchip through our Chip To Save Program!

 These opportunities are provided on occasion throughout the year to help save more lives by increasing the chance of recovery of your lost pet. We care about animals; our mission revolves around helping the homeless, educating the community, and providing life saving programs and services to decrease the number of animals being killed in local shelters while also decreasing the homeless pet population. You can learn more about these opportunities, including when our next opportunity is, by visiting our Recovery Page

If you're interested in sponsoring or contributing towards our next Microchip Event, please DONATE TODAY

Applicant Information
Name *
Name
Home Address *
Home Address
Phone *
Phone
How did you hear about our free microchipping program and events?
Please provide a brief explanation as to why you applied to be selected to receive a free microchip for your pet?
If selected, how will this opportunity benefit you and your pet?
What has prevented you from providing your pets with a microchip prior to this opportunity? We want to know how we can better help the community through education and providing more free opportunities like this.
Pet Information
Cat or Dog?
Sex and Alteration *
Is your pet "fixed"? Please select the most appropriate answer below.
Dog Breeds: Chihuahua, Boxer, Heeler - Cat Breeds: Siamese, Persian, Domestic Shorthaired
Approx. Weight
If you own more than one pet that you would like request to get microchipped at the same time, please list their information below in the following format. (Name, Species, Sex, Alteration, Age, Breed, Color, Weight)
Commitment and Authorization
By typing my name below, I hereby commit to redeeming the benefit of the Microchip Program by taking my pet to get microchipped at the location specified on the voucher provided by A Life to Live. I agree to notify A Life to Live if I am unable to take my pet to get microchipped by the date and time specified on the voucher so that another pet in need may benefit from this opportunity. I certify that the information provided by me in connection with my application, whether on this document or not, is true and complete. I understand that any misstatement, falsification, or omission of information shall be grounds for termination of this application. A Life to Live reserves the right to refuse any application. By typing/signing my name below, I agree with the above terms. *
By typing my name below, I hereby commit to redeeming the benefit of the Microchip Program by taking my pet to get microchipped at the location specified on the voucher provided by A Life to Live. I agree to notify A Life to Live if I am unable to take my pet to get microchipped by the date and time specified on the voucher so that another pet in need may benefit from this opportunity. I certify that the information provided by me in connection with my application, whether on this document or not, is true and complete. I understand that any misstatement, falsification, or omission of information shall be grounds for termination of this application. A Life to Live reserves the right to refuse any application. By typing/signing my name below, I agree with the above terms.

A Life to Live is an incorporated 501(c)(3) nonprofit organization.  © 2017 A Life to Live. All Rights Reserved.