Inmate Donation Form

Circle Tail, Inc.

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Inmate Foster Puppy/Dog Donation Form

Use this form if you'd like to specifically help Circle Tail and the Chillicothe, Ross, Orient, or Lebanon Correctional Institute inmates as they work together to provide assistance dogs for individuals with disabilities.

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*Name(s):

Street Address:

City, State, Zip Code:

Day Phone:

Evening Phone:

E-Mail Address:

Enclosed is my tax deductible contribution:

Full Sponsorship of 1 Inmate/Dog Team: $2,000.00
Partial Sponsorship of 1 Inmate/Dog Team: $

* If multiple individuals are combining to sponsor an inmate/dog team, please provide a separate list of each person's name and address so Circle Tail can recognize and thank each individually.

Thank you for your support. Please print and mail completed form, along with tax deductible contribution, to:

Circle Tail, Inc.
8834 Carey Lane
Pleasant Plain, OH 45162

*Name(s):
Street Address:
City, State, Zip Code:
Day Phone:
Evening Phone:
E-Mail Address:
Enclosed is my tax deductible contribution:	Full Sponsorship of 1 Inmate/Dog Team: $2,000.00 Partial Sponsorship of 1 Inmate/Dog Team: $