Get the free Voluntary Self-Exclusion Facility Form

Iowa Racing & Gaming Commission 1300 Des Moines St., Ste. 100 Des Moines, IA 503095508Iowa Racing & Gaming Commission (IGC)Voluntary SelfExclusion Mailing EnrollmentSection 1: Instructions The information

How to fill out voluntary self-exclusion facility form

How to fill out voluntary self-exclusion facility form

1. To fill out a voluntary self-exclusion facility form, follow these steps:
2. Obtain the form: Contact the organization or facility that offers voluntary self-exclusion programs and request a copy of the form. You may be able to find the form on their website as well.
3. Read the instructions: Carefully read the instructions provided along with the form. Make sure you understand the purpose and terms of the self-exclusion program.
4. Provide personal information: Fill in your personal details such as your full name, address, date of birth, contact number, and email address. Ensure the information is accurate and up-to-date.
5. Choose duration: Select the duration of the self-exclusion period. This can vary from a few months to several years, depending on the options provided by the facility.
6. Agreement and acceptance: Read the declaration or agreement section and mark the box indicating your understanding and acceptance of the terms and conditions.
7. Signature: Sign and date the form in the designated space to acknowledge your voluntary participation in the self-exclusion program.
8. Witness or notary: Some forms may require a witness or notary signature to validate the process. Make sure to follow the instructions provided by the facility.
9. Submission: Submit the completed form as instructed. This may involve mailing it to the facility, delivering it in person, or submitting it online through their website or portal.
10. Keep a copy: It's advisable to keep a copy of the filled-out form for your records.
11. Follow the process: After submitting the form, follow any additional instructions provided by the facility to ensure the self-exclusion takes effect and is enforced correctly.
12. Remember, each facility may have specific procedures and requirements, so it's important to carefully follow their instructions throughout the process.

Who needs voluntary self-exclusion facility form?

1. The voluntary self-exclusion facility form is needed by individuals who wish to voluntarily exclude themselves from participating in specific activities such as gambling, online gaming, or access to certain premises. This form is usually used by individuals who recognize a problem with such activities and seek to limit or eliminate their involvement in order to promote responsible behavior and prevent potential harm or addiction. The form enables individuals to self-exclude for a specific duration and restricts their access to related facilities or services during that period.

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