*JCAS Reclaim Form
Animal's Name
*
Bean (Dog - D66-25)
Diesel (Dog - D65-25)
Newton (Dog - D63-25)
Stanley (Dog - D64-25)
Date Animal Arrived
Reclaim Date
*
Total Days in the Shelter $10.00/day
Initial Reclaim Fee (1st $25.00) (2nd $50.00) (3rd $75.00)
*
TOTAL RECLAIM FEE DUE:
Owner's First Name
*
Owner's Last Name
*
Phone number
*
Phone number
Driver's License #
*
Address
*
City,State,Zip
*
Email Address
*
Emergency Contact for Microchip First/Last Name, Phone number different than yours
Breed
Color
Age
Male/female
*
Spayed/Neutered
No
Yes
Veterinary Facility & Veterinarian Name
*
Veterinarian Phone Number
*
Please attach a photo of the Animal's *CURRENT or EXPIRED* Rabies Certificate. Ensure the Date Vaccinated, Expiration Date, Veterinary Facility, Veterinarian's Signature, and Rabies Tag Number are all clearly visible. If the Animal's Vaccination is expired please refer to the Acknowledgement portion of this Reclaim Form below.
I acknowledge that I have read and understand the following. Reclaim Fees within a three (3) month period are $25.00 per Animal/1st Reclaim, $50.00 per Animal/2nd Reclaim, and $75.00 per Animal/3rd Reclaim. An additional $10.00 Daily Fee is charged for each day the Animal is at the Shelter. Citations will be issued for when an Animal is reclaimed a 3rd time. A $10 Michrochip implantation and Registration Fee will be added on if the animal being reclaimed has not been previously microchipped prior to entering the shelter.
*
No
Yes
I acknowledge that I have read the following. Jasper County Ordinance Section 74.06 requires proof of current rabies vaccination or presentation by the animal owner of a receipt showing prepayment of a veterinarian’s charges for such vaccination. Prepay receipts can be emailed to us at jaspercoanimalshelter@yahoo.com A dog or cat not previously vaccinated must be vaccinated for rabies by a licensed veterinarian within 72 hours after the date of this release, and the owner shall supply proof of same to said animal control agency within 48 hours after the rabies vaccination. Failure of the animal owner to obtain such vaccination will result in a Citation for Harboring a non-immunized dog being issued, and shall constitute a breach of the release agreement and entitle the Animal Control Agency to regain possession of the animal.
*
No
Yes
Signature
*
