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2. POTENTIALLY DANGEROUS ANIMAL (PDA) PERMIT APPLICATION
4. Case Report #
6. First Name
7. Last Name
9. Date of Birth
10. Drivers License #
11. State of Issuance
13. Address1
15. CASTLE ROCK
16. State
17. Zip
19. Phone 1
20. Phone 2
22. Email Address
24. Address where animal will reside (if other than above)
26. Alternative Contact Name
27. Phone
31. Animal Information
33. Animal Name
34. Age
35. Sex

    1. Male
    2. Female
    3. Neutered Male
    4. Spayed Female
37. Species

    1. Dog
    2. Cat
    3. Other
38. If other, list here
39. Breed
41. Color(s)
43. Markings
45. Docupet License#
46. Microchip#
47. Rabies Tag#
49. Veterinary Clinic
50. Vet Phone
52. PERMIT FEE $300.00 NON-REFUNDABLE
    This permit will be in effect for three years, starting from the approval date listed below. Upon expiry of the permit, the dog owner may petition the court to have the PDA restrictions removed. This Permit Application must be submitted within 5 days of conviction.
54. Upload Doc/Image
55. Upload Doc/Image
56. Upload Doc/Image
58. Upload Doc/Image
59. Upload Doc/Image
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61. 1. Receive an email copy of this form.
62. Email address

    This field is not part of the form submission.

63. Submit

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