SELF-BARRING APPOINTMENT REQUEST

Self-Barring Request

Self-barring is one of the ways we can help you wrangle a gambling problem. When you join us for a self-barring appointment, our team will bring information on additional resources to further your journey of recovery.

Please complete the following form to request a Self-Barring appointment with one of our Responsible Gaming Specialists.

Full Name*

Alias / AKA

Email Address*

Street Address*

Zip Code*

Phone Number*

Driver’s License / ID

Issuing State

Date of Birth

Corrective Lenses

Gender

Race

Complexion

Eye Color

Hair Color

Height

Weight

Reason for self-barring*

Desired barring duration*

I understand that by completing the self-barring process, I will no longer be allowed to enter Angel Of The Winds Casino Resort or its property under any circumstance for the period defined above. Doing so could result in criminal trespass or unauthorized entry charges. I understand that any jackpot(s) or winning(s) accrued while trespassing will be forfeited and that Angel Of The Winds Casino Resort and the Stillaguamish Tribe are not liable for losses incurred while trespassing.*

I understand that I will need to appear in person with identification matching the listed information on this form to complete the self-barring process. I also understand that a representative from Angel Of The Winds Casino Resort will contact me within 72 hours using the phone number and/or email address provided on this form, and I authorize them to leave a message regarding my request.*

Please leave this field empty.