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Consent to permanent body art application
NAME (as it appears in your legal ID)
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Birthday
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Address
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The County of Riverside Department of Environmental Health requires all practitioners to keep a copy of their clients form of picture ID for the records. Please, upload a clear picture of your Driver's License, State ID, DOD ID or Passport for the records
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Today's Date
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I have previously had permanent cosmetics or tattoo performed by someone other than Laura Charleston on the same area, that I am asking her to work on in this session.
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