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Get Body Art Release Form - Kansas.gov - Kansas

ION If client is under the age of eighteen (18) parent or legal guardian s name shall also be provided. * CLIENT AGE CLIENT NAME (FIRST, MIDDLE, LAST) CLIENT DATE OF BIRTH CLIENT PHONE NUMBER CLIENT ADDRESS (STREET, CITY, STATE ZIP CODE) PARENT OR LEGAL GUARDIAN DRIVER'S LICENSE NUMBER (IF CLIENT IS UNDER AGE 18)* CLIENT DRIVER'S LICENSE NUMBER SECTION 2: MEDICAL/HEALTH ASSESSMENT - QUESTIONS ARE TO BE ANSWERED BY THE CLENT CLIENT MEDICAL OR SKIN CONDITIONS (CIRCLE/CHECK YES OR NO) DO Y.

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