Tattoo Removal Referral Form

Tattoo Removal Referral Form

Hosted by the Marin County Probation Department in partnership with the New Skin Tattoo Removal Program. This event is designed to support individuals who are working toward new opportunities by helping remove visible tattoos that may present barriers to employment, education, or personal growth.
DATE: SEPTEMBER 24, 2026 (2:00PM-6:00PM)

LOCATION: 3501 CIVIC CENTER DRIVE, SUITE 271, SAN RAFAEL, CA 94903

https://maps.app.goo.gl/NaSURo1jgtPFcBnJA
Your Name

First NameLast Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Your Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Your Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Probation ID Number/Case Number
Probation Officer Name
Appointment
Should be Empty: