Request for Voluntary Self-Exclusion from NY Gaming Facilities
This file is a request form for individuals to voluntarily exclude themselves from all gaming facilities and entities licensed, permitted, or registered by the New York State Gaming Commission. It includes properties such as casinos, horse racing tracks, off-track betting facilities, and interactive fantasy sports activities. Completing this form ensures individuals are excluded from these gaming activities for a specified period.
Edit, Download, and Sign the Request for Voluntary Self-Exclusion from NY Gaming Facilities
Form
eSign
Add Annotation
Share Form
How do I fill this out?
To fill out this form, you'll need to provide personal information and select the duration of your self-exclusion. Gather all necessary details, such as your name, address, and social security number, before starting. Follow the instructions carefully to ensure your self-exclusion request is processed correctly.
How to fill out the Request for Voluntary Self-Exclusion from NY Gaming Facilities?
1
Gather your personal information including name, address, and social security number.
2
Enter your details in the relevant fields provided in the form.
3
Select the period for which you wish to be excluded from gaming activities.
4
Initial and sign the acknowledgment and waiver sections as required.
5
Review your information and submit the completed form.
Who needs the Request for Voluntary Self-Exclusion from NY Gaming Facilities?
1
Individuals who have a gambling problem and wish to exclude themselves from gaming activities for their well-being.
2
Family members of individuals with gambling issues who want to help their loved ones stay away from gaming activities.
3
Mental health professionals aiding clients with gambling addiction by providing them with resources to self-exclude from gaming facilities.
4
Gaming facility operators who need to comply with regulatory requirements by maintaining self-exclusion lists.
5
Counselors and support groups assisting clients in their journey to recovery from gambling addiction.
How PrintFriendly Works
At PrintFriendly.com, you can edit, sign, share, and download the Request for Voluntary Self-Exclusion from NY Gaming Facilities along with hundreds of thousands of other documents. Our platform helps you seamlessly edit PDFs and other documents online. You can edit our large library of pre-existing files and upload your own documents. Managing PDFs has never been easier.
Edit your Request for Voluntary Self-Exclusion from NY Gaming Facilities online.
With PrintFriendly, you can easily edit this PDF by clicking on the text fields and entering the required information. The editor allows you to make changes to any part of the form to ensure accuracy. Save your edits once you are satisfied with the information provided.
Add your legally-binding signature.
PrintFriendly now offers an e-signature feature that allows you to sign this PDF directly online. Simply open the form in our editor and use the signature tool to add your signature. You can then save the signed document and submit it as needed.
Share your form instantly.
Sharing PDFs on PrintFriendly is simple and efficient. After editing your document, use the share feature to send the form via email or generate a shareable link. You can easily distribute the completed and signed form to relevant parties without leaving the platform.
How do I edit the Request for Voluntary Self-Exclusion from NY Gaming Facilities online?
With PrintFriendly, you can easily edit this PDF by clicking on the text fields and entering the required information. The editor allows you to make changes to any part of the form to ensure accuracy. Save your edits once you are satisfied with the information provided.
1
Open the PDF in PrintFriendly's editor.
2
Click on the text fields and enter your information.
3
Use the editing tools to make any necessary corrections.
4
Review your entries to ensure everything is accurate.
5
Save and download the edited PDF.
What are the instructions for submitting this form?
Submit this form to the New York State Gaming Commission or the relevant gaming facility's designated intake employee. You can submit the form via email, fax, or mail. For email submissions, send to gaming_exclusion@nygaming.gov. For fax submissions, use 555-123-4567. For mail submissions, send to New York State Gaming Commission, Self-Exclusion Department, P.O. Box 12345, Albany, NY 12201. Ensure all sections are completed and signed before submission.
What are the important dates for this form in 2024 and 2025?
The important dates for this form in 2024 and 2025 include any deadlines or submission periods set by the New York State Gaming Commission. Please check their official website for the most updated information.
What is the purpose of this form?
The purpose of this form is to provide individuals with a means to voluntarily exclude themselves from all gaming facilities and entities licensed by the New York State Gaming Commission. This form aims to support individuals dealing with gambling addiction by preventing their access to various gaming activities, including casinos, horse racing, off-track betting, video lottery gaming, and interactive fantasy sports. By completing this form, individuals can ensure their self-exclusion is enforced for the specified period, aiding them in their journey to recovery and helping them avoid any trigger environments.
Tell me about this form and its components and fields line-by-line.
- 1. Name: Enter your last, first, and middle names. Also, provide any additional names you use, such as maiden names, aliases, or nicknames.
- 2. Home Address: Provide your complete residential address, including number and street, apartment number, city, state, and zip code.
- 3. Preferred Telephone Number: Include your area code and phone number for contact purposes.
- 4. Social Security Number: Enter your social security number or another number from a government-issued identification for enforcement purposes.
- 5. Date of Birth: Provide your date of birth in the format MM/DD/YY.
- 6. Physical Characteristics: Enter details about your height, weight, gender, hair color, eye color, race, and any other distinguishing physical characteristics.
- 7. Exclusion Period: Select the period for which you request to be excluded from all gaming activities.
- 8. Acknowledgement: Initial and sign the statements confirming your understanding and agreement to the terms of the exclusion.
What happens if I fail to submit this form?
Failure to submit this form will result in not being excluded from gaming activities, allowing continued access to gaming facilities. This may hinder individuals dealing with gambling addiction in their recovery process.
- Continued Access to Gaming Facilities: Individuals will not be placed on the self-exclusion list and can still enter gaming facilities.
- No Support for Gambling Addiction: Not submitting the form means individuals will not receive the intended support to stay away from trigger environments.
How do I know when to use this form?
- 1. Self-Exclusion: Individuals who want to ensure they are not allowed into gaming facilities for a specified period.
- 2. Support Recovery: Those seeking to aid their recovery process from gambling addiction by eliminating access to gaming environments.
Frequently Asked Question
How do I fill out this form on PrintFriendly?
Open the form in PrintFriendly's editor, enter your information in the text fields, and use the tools to make any necessary corrections.
Can I sign this form electronically on PrintFriendly?
Yes, PrintFriendly offers an e-signature feature that allows you to sign the form directly online.
How do I share the completed form on PrintFriendly?
Use the share feature to send the form via email or generate a shareable link.
What personal information do I need to provide?
You need to provide your name, address, social security number, and other identifying details.
How do I select the self-exclusion period?
Choose the period of exclusion from the given options on the form: one year, three years, five years, or lifetime.
What happens if I enter a gaming facility during the exclusion period?
You will be subject to arrest for criminal trespass and your exclusion period will be increased.
Can I edit the form multiple times before submitting?
Yes, you can make edits and review the form as many times as needed before submitting.
Will my personal information be shared?
Your information will be shared with the New York State Gaming Commission and relevant entities for enforcement purposes.
How do I know if my self-exclusion request has been processed?
You will receive confirmation from the New York State Gaming Commission or the facility handling your request.
Can I extend my self-exclusion period in the future?
Yes, you can request to extend your term of voluntary self-exclusion in the future.
