Inmate Foster Puppy/Dog Donation Form

Complete and print this form if you'd like to specifically help Circle Tail and the Ohio Reformatory for Women, Dayton or Ross Correctional Institute inmates as they work together to provide assistance dogs for individuals with disabilities.

Privacy Statement

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 individual.

Thank you for your support. Circle Tail is a 501(c)(3), non profit corporation. After you complete and print this form, please mail the printed form, along with your contribution, to:

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