Survivor Application 2026

Hey Friend! Thank you for your courage in reaching out. We appreciate the trust you place in (ARI) Atlanta Redemption Ink and honor the vulnerability it takes to reach out.

Our services are made possible through the generosity of trauma-informed artists, removal technicians, community donors, & volunteers, and we strive to ensure all interactions remain respectful, safe, and supportive for everyone involved.

For residential programs, MDTs, or agencies seeking tattoo services for clients or minors please contact admin@arionline.org with a referral from your agency/organization.

Please note that all tattoos are thoughtfully reviewed, and scars must be fully healed (generally 6 months to 1 year, or at the artist’s discretion) before any cover-up services can be considered.

Thank you for your patience and understanding as we continue to provide these services with care, integrity, and compassion.

The ARI Team

Name*

First NameLast Name

Birthdate*

Date

Pronouns

If you prefer not to disclose, put N/A

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Please enter a valid phone number.

Can we text you or leave a voice mail?*

TextVoicemailBoth

Email*

example@example.com

Date of last tattoo session or tattoo removal*

Date

Service Needed*

Tattoo Cover-upRemoval

Why are you seeking a cover-up*

Trafficking/Commercial Sexual ExploitationSelf Harm (scars)Gang Affiliation or Hate Group Affiliation (this will be verified)Visible Track Mark Scarring

If related to commercial exploitation, did someone force/coerce you to get this tattoo?*

YesNoN/a

Location/description of what needs to be covered & how was it obtained?*

Are there certain times to year that trigger memories regarding this tattoo?*

YesNoPrefer not to discloseN/A

How old were you when this tattoo or scar was obtained?*

If you would like to disclose, what time of the year?

Upload an image of the area needing a cover-up or removal (no image/bogus images, or unclear image of the area needing services will not be reviewed (no zip/pdf)*

Do you feel like you’re getting the community support and care that you need after exiting the life/game or in recovery?*

YesNoN/A

Support Services Needed*

Counseling Services & Life Coaching (Zoom Sessions Available)Highschool DiplomaN/A

What gang/hate group is your tattoo affiliated with?*

If gang/hate group affiliated: If you are willing to share, at what age did you become involved in this group? What life circumstances brought you into the life and what encouraged you to exit?*

If you are needing tattoo cover-up - Where was your tattoo received?*

How will this cover-up/removal impact your future?*

How did you hear about Atlanta Redemption Ink (ARI)?*

Are you currently in a residential program? *

I acknowledge that I personally am taking a step in my own journey by applying. ARI takes the time to carefully screen and match individuals with our partnered shops and removal specialists. I understand that missing appointments, no-shows, or repeated rescheduling, lack of communication may result in delays in receiving services or removed from applying*

Agree

ARI is dedicated to inclusion and respect. We do not discriminate on the basis of race, color, religion, gender, gender expression, age, national origin, disability, marital status, sexual orientation, or military status. We value and welcome the unique contributions of every individual in our community.*

agreed/understand

This program is available for individuals who are unable to afford removals, cover-up services for scars or tattoos. While ARI is committed to offering assistance where there is genuine need, submitting an application does not guarantee services. We will reach out if we are able to provide help, and we respectfully ask that you do not contact us repeatedly for updates or misuse this service. Additionally, please be aware that ARI does not offer full sleeve tattoos or large-scale pieces. For scar cover-ups, the area must be healed for 6 months to 1 year, based on the artist's discretion..*

AGREE/Understand

I agree that I have stated above is correct & I have read through each portion*

AGREE