In Home Service/Hearing/Companion Dog
An In Home service or hearing dog is a dog that is trained in specific service or hearing dog skills such that they can perform the skills in the home for a person with a disability. An In Home companion dog is a dog that is provided to a family that has a child with a specific need because of a disability.
An In Home service, hearing, or companion dog may be right for you and/or your family member if:
- You have a disability and would benefit from some extra assistance in the home while others are gone, but you typically have family or friends that accompany you when you are out.
- You have a hearing impairment and manage just fine with hearing aids but don’t want to wear them when you are home.
- You have a child with a disability who would benefit from the calming presence of a dog and his/her companionship.
- You have a pre-teen (10+) or teen with a disability who would benefit from a task trained dog but is not yet ready for the responsibility of a public access service/hearing dog.
If you think an In Home service, hearing or companion dog might be right for your or a family member, please complete the In Home Service/ Hearing/ Companion Dog Application below. Once we receive this form, we will contact you for a phone interview. In most cases we will have you come to Circle Tail for an interview so we can gather more information on you or your family member's needs.
In Home Service/Hearing/Companion Dog Application
Use this form to apply for a Circle Tail In Home Service/Hearing/Companion dog for yourself or a family member. We are requesting this information to guide us in making the best match between you, your family and one of our dogs.
Please complete all questions, read the "In Home Service/Hearing/Companion Dog Adoption Agreement" that follows the questions and submit the form to Circle Tail.
Please note, besides this application, we will have a phone conversation, an interview at Circle Tail, and a home visit for the potential recipient and family. Training will be required prior to and following placement of the dog. The amount of training will depend on the team’s needs.
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The following three things will happen next:
1. You Will See a Thank You Page.
If you have completed all required fields, once you click Submit, you will see a Thank You page. If you have not completed all required fields, you will be asked to complete the required fields before the form can be submitted and you see the Thank You page. Use NA, if a field is not applicable.
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If you have completed all required fields, once you click Submit, you and Circle Tail will be sent an auto-response email containing the information you supplied for the form. If you do not receive the email, please click the back button on your browser and make sure your email address is correct and click the Submit button again. Also check your spam or junk mail folder.
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Circle Tail, Inc.
8834 Carey Lane
Pleasant Plain, OH 45162