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Self-Exclusion Form (CGCC-037, Rev. 07/17) 2026
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- Click ‘Get Form’ to open the Self-Exclusion Form in our editor.
- Begin by filling out Section 1: Personal Information. Enter your full legal name, any other names you may have used, and your contact details including home and business numbers.
- In Section 2, indicate your desired term of exclusion by initialing next to either 'Lifetime' or 'One Year'.
- Complete Section 3: Photo and Visual Description. Provide your date of birth, race/ethnicity, hair and eye color, height, weight, and affix a recent passport-quality photograph.
- In Section 4: Declaration, read through the statements carefully. Initial each statement to confirm your understanding and agreement.
- If required, complete Section 5 for notarization or witness signature before submitting the form as instructed.
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