New Legacy Program

On a case to case basis, we offer pro bono and sliding scale prices to those who need our services to remove gang-affiliated and/or tattoos associated with hateful symbolism, drug use, or domestic violence.

We created this form to streamline the process of applying for our New Legacy Program.

If the form is not working for you, or you do not want to share any of this information online – please do not hesitate to reach out.

You can reach out to us via phone, text, email, or social media – or come in and visit at the shop.

If you do not show up for an appointment without letting us know, you will be removed from the program.

First Name *

Last Name *

Phone Number *

Email *

Preferred Contact *

• Text
• Call
• Email

I consent to being contacted by the staff of Legacy Tattoo Removal Limited.

We promise not to share your information with any outside party for any reason.

YesNo

Type of Tattoo *

• Gang Affiliated
• Track Marks
• Hate Symbol
• Domestic Violence
• Human Trafficking
• Prison or Jail

Referred By *

• Parole Officer
• Social Worker
• Community Outreach Worker
• Doctor
• Mental Health Worker
• Sponsor

Photos

1

Tattoo Photo

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Police Case Number *

Letter of Support *

Please provide a letter written by one of the above mentioned people that referred you who are working alongside you building your New Legacy.

File name:

File size:

Anything else to add?

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