North County Tattoo Removal Program

Tattoo Removal Application
PLEASE READ BEFORE COMPLETING THE APPLICATION !
In order to qualify for the North County Tattoo Removal Program you must meet the following criteria:

1. Live in North San Diego County(Poway, Rancho Bernardo, Escondido, Fallbrook, San Marcos, Vista, Carlsbad, Oceanside).
2. Have visible gang related tattoo(s) such as on head, face, neck, hands, etc. Non-visible tattoos (such as back, chest, feet, etc.) will NOT be accepted.
3. No longer have contact with gangs, gang members or gang activity.

*Note: There is no age requirement for the program; but, priority will be given to those between the ages of 18-35.

**Please allow up to three weeks to hear a response regarding your application. **

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* 1. What is your first name?

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* 2. What is your last name?

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* 3. Date of Birth:

Date / Time

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* 4. Age:

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* 5. What is your sex?

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* 6. Are you a resident of North San Diego County? "North" refers to the cities of Poway, Rancho Bernardo, Escondido, Fallbrook, San Marcos, Vista, Carlsbad, Oceanside.

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* 7. What is your address?

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* 8. Please provide a phone number where we can best reach you.

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* 9. What is your email address?

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* 10. Have you ever been arrested?

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* 11. If yes, list the charge(s). (Enter "N/A" if you have not been arrested)

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* 12. If yes, what is the date of your last arrest?

Date / Time

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* 13. Are you currently on Probation or Parole?

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* 14. If yes, what is your Probation/Parole Officer's name?

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* 15. How many visible tattoos do you have?

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* 16. Where are your visible tattoos located? (Mark All That Apply)

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* 17. My tattoos are...(Select All That Apply)

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* 18. I got my tattoo(s) to represent a gang or gang life.

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* 19. My tattoo(s) can be described as...(Pick the one that most closely applies)

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* 20. My tattoo(s) have kept me from...(select all that apply)

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* 21. Have you earned a high school diploma or high school equivalency(GED or HiSET)?

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* 22. Are you attending school? (Select whichever applies)

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* 23. Are you currently employed?

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* 24. How did you hear about this program?

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* 25. Why is it important for you to have your tattoo(s) removed?

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