&noscript=1 /> Voluntary Self-Exclusion Request - Four Winds Casinos
`

Voluntary Self-Exclusion Request

Important: Your self-exclusion request is not effective until it has been reviewed, verified, and confirmed by Four Winds Casino.

 

How to Submit Your Request

You may submit your Voluntary Self-Exclusion Request using one of the following methods:

Option 1 — Download and Email the Form

Download the Voluntary Self-Exclusion Request Form and complete it offline. 

Before submitting your request, please ensure you:

 

  • Complete all required fields.
  • Sign the form.
  • Take a clear digital selfie photo of yourself holding your valid government-issued photo ID. Printed or scanned copies of photographs will not be accepted.
  • Attach the selfie photo and completed form to an email sent from the email address registered to your Four Winds Online account.
Email your request to:
iGamingSelfExclusion@fourwindscasino.com

Option 2 : Complete the Online Form

Complete and submit the online form below.
By submitting this form, you are requesting exclusion from all Four Winds Online Casino and Online Sports Betting activities.

*Required fields

 

Contact Information

Any personal information collected through this process will be kept confidential and handled in accordance with the Four Winds Casinos Privacy Policy for more information.

    *FIRST NAME


    *LAST NAME


    DATE OF BIRTH:

    Last 4 Digits of SSN:

    PHONE NUMBER


    EMAIL ADDRESS (registered to account):


    CITY

    *STATE/PROVINCE

    *ZIP/POSTAL CODE

    COUNTRY

    *BRIEF DESCRIPTION OF EVENTS AND QUESTIONS:


    *Take a clear selfie while holding a valid government-issued photo ID.

    **Screenshots or images of IDs alone will not be accepted.

     

    *Take a clear image of your Digital Signature and upload it

    Self-Exclusion Term

     

    Acknowledgement and Authorization

    By signing below, I acknowledge and agree that:

     

     

    Reservations & Information

    1-866-4WINDS1 (1-866-494-6371)

    iGaming Support

    Looking for assistance with our online casino?

    Click here to see the FAQ, Live Chat with a representative or submit a request to our team!