Get Request For Self-exclusion.pdf - Louisiana Gaming Control Board

This guide provides clear instructions on how to complete the Request For Self-Exclusion form for the Louisiana Gaming Control Board. Whether you are seeking to self-exclude from gaming activities due to compulsive gambling or other reasons, this step-by-step approach is designed to assist you in filling out the form accurately and efficiently.

Follow the steps to successfully complete the form online.

1. Click the ‘Get Form’ button to access the Request For Self-Exclusion form. This will allow you to open the document in your preferred online editing tool.
2. Begin filling out the form by providing your full name in the designated fields. Include any suffixes such as Sr., Jr., or others if applicable.
3. If you use any other names, such as a maiden name or any aliases, mark 'Yes' and list these names in the space provided.
4. Enter your home address, including the number, street, apartment number, city, state, and ZIP code.
5. Provide your home telephone number, making sure to include the area code.
6. Input your Social Security number. Note that providing this information is voluntary and you can refer to instructions for more details.
7. Fill in your date of birth by including the month, day, and year in the specified format.
8. Indicate your height using the feet and inches format.
9. Record your weight in pounds in the provided space.
10. Select your gender by checking the appropriate box, either Male (M) or Female (F).
11. Choose your hair color by marking the relevant option from the provided choices.
12. Select your eye color from the available options.
13. List any other distinguishing physical characteristics, such as scars or tattoos, if applicable.
14. Enter your driver’s license or ID number along with the state that issued it.
15. Review the waiver and release section carefully, ensuring you understand your rights and the implications of requesting self-exclusion.
16. Read the acknowledgment statement and confirm your understanding and agreement by signing and dating the form.
17. Upon completing the form, you can save your changes, download a copy, print it, or share it as necessary.

Take the next step towards responsible gaming by completing your Request For Self-Exclusion online today.