Self-Exclusion Form (CGCC-037, Rev. 07/17) 2026

1. Click ‘Get Form’ to open the Self-Exclusion Form in our editor.
2. 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.
3. In Section 2, indicate your desired term of exclusion by initialing next to either 'Lifetime' or 'One Year'.
4. 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.
5. In Section 4: Declaration, read through the statements carefully. Initial each statement to confirm your understanding and agreement.
6. If required, complete Section 5 for notarization or witness signature before submitting the form as instructed.

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