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Arizona Department of Gaming SelfExclusion Form Please print clearly: Full Name: SS #: Street Address: Date of Birth: City: Zip Code: State: Home Phone: Business Phone Height: Driver's License #/State

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What is selfexclusion form?

Self-exclusion form is a document that allows individuals to voluntarily ban themselves from participating in certain activities, such as gambling, for a specific period of time.

Who is required to file selfexclusion form?

Any individual who wishes to exclude themselves from a specific activity, such as gambling, is required to file a self-exclusion form.

How to fill out selfexclusion form?

To fill out a self-exclusion form, individuals typically need to provide their personal information, indicate the length of the self-exclusion period, and sign the form to acknowledge their agreement to the terms.

What is the purpose of selfexclusion form?

The purpose of a self-exclusion form is to help individuals who may have a problem with a certain activity, such as gambling, to take a break and seek help if needed.

What information must be reported on selfexclusion form?

Typically, self-exclusion forms require individuals to provide their full name, contact information, identification details, and the length of time they wish to self-exclude.

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