RECLAIM RELEASE
<<Organization>>
<<OrganizationAddress>>, <<OrganizationCity>> <<OrganizationState>> <<OrganizationZipcode>>
 <<OrganizationTelephone>>

Animal: <<AnimalName>>	ReleaseDate: <<Date>>
Shelter Code: <<ShelterCode>>	Breed: <<BreedName>>
Reclaimed By: <OwnerForenames>> <<OwnerSurname>>	Species: <<Species>>
Sex of Animal: <<Sex>>	Color: <<BaseColourName>>
Spayed/Neutered: <<Neutered>>	Microchip: <<MicrochipNumber>>

I, the undersigned, do hereby request <<Organization>> to release the above-named animal into my custody. I do hereby certify that I am the owner or duly authorized agent for the owner of the animal described above and that I am authorized to reclaim the above-named animal from <<Organization>>.

I understand that:

The above-named animal cannot be released to me without proof of ownership (such as photos, adoption documents or veterinary records).
Every person who owns, possesses, or harbors or keeps a dog or cat over three months old shall have and keep such dog or cat inoculated against rabies. The vaccination should be administered annually and given by a licensed veterinarian.
Before release of the above-named animal to me, I must provide proof of a current rabies vaccine.
If I cannot provide proof that the above-named animal has a current rabies vaccination, I must provide a pre-paid document from a local veterinarian to prove purchase of a rabies vaccination, to be administered by the documented veterinarian upon release of the above-named animal into my custody.
I must pay daily boarding fees and a fine to reclaim the above-named animal.
It is unlawful for any dog, cat, domesticated livestock, or any other owned animal to run at large upon the streets, alleys, or other public or private property not my own unless restrained by a leash or lead.
All domesticated animals must be SECURELY confined to my property and violations of any of the above laws may result in my animal being impounded, or charges being filed against me, or both.

By signing this document I certify I have read, understand and agree to the terms, conditions and policies outlined above which have been established by the Jackson County Animal Shelter.

OWNER OR OWNER'S REPRESENTATIVE RELEASE INFORMATION

Owner or Owner's Representative: <<OwnerForenames>> <<OwnerSurname>>

Address: <<OwnerAddress>>

City: <<OwnerCity>> State: <<OwnerState>> ZipCode: <<OwnerZIPCode>>

C Phone: <<MobilePhone>> W Phone: <<WorkPhone>> H Phone: <<HomePhone>>

DATE: <<Date>> OWNER/REPRESENTATIVE SIGNATURE:

DATE: <<Date>> SHELTER STAFF SIGNATURE:

Animal Reclaim Release created by <<UserName>> on <<Date>>. Animal Record created by <<AnimalCreatedBy>> on <<AnimalCreatedDate>>. Animal Record last updated by <<AnimalLastChangedBy>> on <<AnimalLastChangedDate>>.