Request for Self-Exclusion from Casino Gaming Instructions

1. Please read these Instructions and the Request for Self-exclusion (the "Request Form"), including the waiver and acknowledgement, carefully. By signing and submitting the Request Form, you are acknowledging that you are a compulsive and/or problem gambler and agreeing to be excluded from casino gaming activities at all casino gaming establishments regulated by the Louisiana Gaming Control Board (“Board”). Casino gaming establishments regulated by the Board include all licensed riverboat casinos, all pari-mutuel live racing facility casinos, and the official gaming establishment (Landbase casino) in New Orleans, Louisiana. This means you cannot engage in gaming, receive or use complimentary goods or services, be a member of a slot or players club, receive credit from any casino, cash checks at a casino, collect winnings or any other thing of value or recover losses. Also, the casinos are to remove your name from their direct marketing lists.
    
2. The completed Request Form must be submitted in person by the person requesting self-exclusion at one of the following Department of Public Safety, Office of State Police (“State Police”) locations during normal business hours. In order to ensure that a Division Agent will be available it is always best to schedule an appointment at the appropriate field office.
   
   

   Gaming Operations Section 7919 Independence Boulevard, A-28 Baton Rouge, Louisiana 70806 (225) 925-1900 or 1901	Gaming Operations Section New Orleans Field Office 1450 Poydras Street, Suite 1300 New Orleans, LA 70112-1214 (504) 310-7000
   Gaming Operations Section Lake Charles Field Office 750 Bayou Pines East Lake Charles, Louisiana 70601 (337) 491-2850	Gaming Operations Section Shreveport Field Office 3010 Knight St., Ste. 270 Shreveport, Louisiana 71105 (318) 862-9730
   Gaming Operations Section Lafayette Field Office 2020 West Pinhook Suite 401 Lafayette, Louisiana 70508 (337)262-5795

   
   
3. You must present valid identification such as a driver's license, passport, or military identification card. Your photograph will be taken by State Police personnel.
    
4. Your photograph and identifying information will be distributed to appropriate personnel of the Casino Operator, Casino Manager, and all casino gaming licensees. The information contained in the Request Form and the self-exclusion list maintained by the Board is not open to public inspection and every effort will be made to maintain its confidentiality. However, neither the Board, State Police, nor the Louisiana Department of Justice, Office of the Attorney General (“Attorney General’s Office”) are liable for any disclosures of such information other than a willful unlawful disclosure. Further, the Casino Operator, Casino Manager and all casino gaming licensees may alert other Louisiana casino gaming establishments to be on the look out for you if you are discovered attempting to engage in gaming activities while on the self-exclusion list.
    
5. In accordance with Section 5 of the Privacy Act, 7 U.S.C. 522a, disclosure of your social security number ("SSN") to the Board is voluntary. Failure to provide your SSN is not grounds for denial of your request for self-exclusion. The request for your SSN is made pursuant to the Louisiana Gaming Control Law, La. R.S. 27:1, et seq. (Specifically La. R.S. 27:27.1(D). If provided, your SSN will be disclosed to Louisiana casino gaming licensees, including the Casino Operator and Casino Manager, for their use in identifying you as a self-excluded person in order to deny you credit, check cashing and similar privileges, and for purposes of withholding money or things of value obtained by you or owed to you as a result of wagers made by you while on the self-exclusion list.
    
6. Your name will remain on the self-exclusion list and you will be excluded from casino gaming activities at all casino gaming establishments regulated by the Board for a minimum of five (5) years. After the expiration of five years from the date you received written notice of self-exclusion from the Board, your name will remain on the self-exclusion list. Your name will not be removed unless 1) you request that it be removed; 2) a hearing is held; and 3) there is a final decision of the Board determining that there is no longer a basis for you to be maintained on the self-exclusion list; however, you cannot request removal from the list before five (5) years have elapsed from the date you received written notice of self-exclusion from the Board.
    
7. It is your responsibility to refrain from gaming activities. Neither the Board, State Police, nor the Attorney General’s Office are liable for any acts or omissions in processing or enforcement of your request for self-exclusion, including failure to withhold your gaming privileges. However, if you are caught gambling at a casino, any winnings, including any chips, tokens, or electronic gaming device credits in your possession will be withheld and remitted to the State of Louisiana, you will be escorted from the gaming floor, and may be subject to arrest pursuant to the Gaming Control Law or any other applicable provisions of law. Further, neither the Board, State Police, nor the Attorney General’s Office are liable for any acts or omissions in processing or enforcement of any later request by you to be removed from the self-exclusion list or your removal from the self-exclusion list.
    
8. For the statutes and rules governing self-exclusion, see the Louisiana Gaming Control Law at La. R.S. 27:27.1(D) and the regulations set forth at LAC 42:III.304.