Request to be Placed on the Internet Gaming Self-Exclusion List and Release

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1 The Purpose of Self-Exclusion This program is a voluntary self-help tool that offers players the opportunity to avoid playing on OLG s Internet Gaming website, PlayOLG.ca. Based on experience and evidence gathered from gamblers, gambling clinicians and academic researchers, OLG recommends combining participation in self-exclusion ( Self-Exclusion ) with other supports, such as gambling treatment programs, financial counselling, and relationship counselling. Taken together, these steps can help an individual to control his or her gambling behaviour. Because the success of the program depends on an individual s own personal commitment not to gamble, the person who enters Self-Exclusion remains solely responsible for his or her own gambling. This program is available to all OLG Internet Gaming players, regardless of their history or pattern of play. Any player has the option to enter the program for any reason whatsoever. Step 1: Acknowledgements WARNING: This is an important legal document. Agreeing to Self-Exclusion waives various legal rights you may otherwise have. Please read this information carefully and take the opportunity to obtain independent legal advice if you so desire. My Obligations Within this agreement, the term "OLG" shall be used to refer to the Ontario Lottery and Gaming Corporation, the Province of Ontario, third-party service providers of Internet Gaming products and services, and their respective agents, employees, officers and directors (past and present). I request to be placed on OLG's list of Internet Gaming self-excluded persons (the "List"). I acknowledge that it is solely my responsibility to refrain from visiting the OLG Internet Gaming website and gambling on this website in the future. I acknowledge that the List applies to all OLG Internet Gaming products and services. My Internet Gaming username is. I acknowledge that I am not permitted to have more than one account, and that if I have created more than one account contrary to the prohibition against doing so, I will not be placed on the List for such other account(s). It is my responsibility to refrain from gambling. I also acknowledge that I am not permitted to play on the Internet Gaming website using someone else's account. I understand that I am now ineligible to wager on any games at PlayOLG.ca or participate in any Internet Gaming players' programs and promotional offers. I will not participate in any future Internet Gaming events or tournaments in which I am currently registered or scheduled to play. Release of Liability I acknowledge that participating in the Self-Exclusion program is my choice. As a condition of my participation in this voluntary program, I must agree not to sue OLG for any reason arising from my participation. I acknowledge and agree that aside from OLG's specific obligations set out in this form, OLG owes me no responsibility or obligation to prevent me from accessing the OLG Internet Gaming website, to prevent or remove my access to the OLG Internet Gaming website should I try to access the website, or to stop me from gambling. In consideration for being placed on the List, the sufficiency of which I hereby acknowledge, I agree to release and not to sue OLG (or any third party who may claim contribution or indemnity from OLG) for any claims or causes of action that I have or may have, arising out of any act or omission by OLG should I gamble in any manner, on OLG's Internet Gaming website or elsewhere. The foregoing release shall include any form of harm or loss including, but not limited to, any financial loss, physical injury or emotional distress of any kind. This release will apply to any kind of act or omission by OLG relating to my continued gambling, including without limitation intentional, reckless or negligent acts or omissions. This release is intended to apply as broadly as possible to any and all potential liability of OLG in respect of my continued gambling of any kind. If I keep gambling it is my responsibility, not OLG's. For greater certainty, and without limiting the generality of the foregoing, I agree that I cannot recover and release any claim in respect of any gambling losses that I may incur if I continue to gamble, and lose. I am solely responsible for my gambling. I acknowledge that if, contrary to my obligations under this form, I gamble on OLG s Internet Gaming website and win, OLG will not pay out any winnings and I release any claims in respect of such gambling winnings. Request to be Placed on the Internet Gaming Self-Exclusion List and Release Page 1 of 5

2 I acknowledge that OLG may forward, as reasonably necessary to perform its duties under the form, the contents of this request to any third-party Internet Gaming service provider, or their agents or employees, and that no breach of confidentiality or any other cause of action or claim will arise as a result. I have read and I understand the waivers and releases of liability set out in this form. I have had the opportunity to obtain independent legal advice before consenting to register in the Self-Exclusion program. OLG s Obligations As soon as reasonably practicable after I register in the Self-Exclusion program, OLG will lock my Internet Gaming account. OLG will record my registration in the Self-Exclusion program within my player profile. This may affect future communications made by OLG. OLG will, within 30 days, remove me from OLG communication lists. I understand, however, that I may receive marketing materials to the extent that communications have already been initiated and cannot be stopped, and to the extent such communications are sent to the public at large. I may also receive marketing or advertisements aimed to the population at large or various segments of it, or to anyone with whom I share an address who has signed up to receive such communications. OLG will refund to me the balance owed in my Internet Gaming account at the time of Self-Exclusion, according to OLG policies. Any outstanding bets, winnings accrued from outstanding bets, refundable entry fees, rewards points and bonus balances eligible for cash redemption will be refunded in accordance with OLG policies. Completed lottery ticket purchases will not be refunded. In the event that a lottery ticket purchase completed prior to registering in the Self-Exclusion program is determined to be a winning ticket, any prizes associated with that ticket will be paid in accordance with OLG Prize Claim procedures. I acknowledge that players who are registered in the Self-Exclusion program are not permitted to purchase lottery tickets online through PlayOLG.ca or to win associated lottery prizes. Upon completion of the Self-Exclusion registration process, OLG will provide me with a downloadable and printable PDF package confirming my successful registration. I acknowledge that it is my responsibility to download, save, and/or print this package for my records. This package includes: Information about my option to voluntarily self-exclude from OLG s land-based casino and slots gambling sites Information and instructions about the refund of my account balance The toll-free phone number for the Ontario Problem Gambling Helpline and further resources on responsible gambling. I acknowledge that it is my responsibility and decision whether or not to seek treatment or counselling. Limitations of the Program I understand that being placed on the List does not result in Self-Exclusion from any of OLG s casino or slots facilities, and that OLG does not assume, in connection with this Self-Exclusion form, any responsibility to prohibit me from entering, or to remove me from, any such casino or slots facilities. I acknowledge that I may receive communications from OLG for account administration purposes during my registration in the Self-Exclusion program. This form and the PlayOLG.ca Player Agreement Terms and Conditions of Use for PlayOLG.ca (the "Player Agreement") constitute my entire agreement with OLG. OLG has not made and I do not rely on any representations to me about the List outside of this form. This form and the Program are governed by the laws of the Province of Ontario and the federal laws of Canada applicable therein. Request to be Placed on the Internet Gaming Self-Exclusion List and Release Page 2 of 5

3 Step 2: Set Self-Exclusion term and acknowledge requirements for Reinstatement Term of Exclusion I understand that the Self-Exclusion program offers different periods of exclusion. I have chosen to be excluded for a term of: Six months One year Indefinite Continuation of Self-Exclusion: If I have selected a six-month or one-year term, I acknowledge that this period constitutes the minimum time I will be self-excluded. I acknowledge that upon such expiry of my selected term, I will remain on the List unless and until I apply for, and am accepted for, reinstatement to OLG s Internet Gaming platform. I acknowledge that if I wish to select a new six-month or one-year minimum period of Self-Exclusion, it is my responsibility to do so. I acknowledge that if I self-exclude from Internet Gaming for the third time in a three-year period, my term of Self-Exclusion from Internet Gaming shall be for a minimum of one year. I acknowledge that decisions related to the acceptance or denial of reinstatement applications are made in accordance with OLG policies on reinstatement. I acknowledge that a copy of this agreement will be included in the confirmation provided to me at the end of this process. I acknowledge that it is my responsibility to download, save, and/or print this package for my records. Request to be Placed on the Internet Gaming Self-Exclusion List and Release Page 3 of 5

4 Step 3: Verification and consent for personal information and final acknowledgement Personal Information Notice: Personal information contained on this form is collected and retained pursuant to the Ontario Lottery and Gaming Corporation Act, 1999 as well as The Gaming Control Act. This information will be used to identify you for the purposes of managing the Self-Exclusion program. This information will be stored in databases by or on behalf of OLG for the purpose of maintaining your status as a self-excluded person, and will be accessible to those employees of OLG (or its third party Internet Gaming service providers) responsible for carrying out the Self-Exclusion program. This information will also be used to cease the transmission of marketing materials to you, and it will be stored on databases maintained by or on behalf of OLG. For further information about OLG s privacy practices for Internet Gaming, please refer to the PlayOLG Privacy Policy, which is available on PlayOLG.ca. You may also contact PlayOLG Player Services at PLAY (7529) should you have any questions or complaints about OLG s handling or management of your personal information collected on this form. I consent to having personal information needed to identify me stored in a database and disclosed to the employees of OLG and OLG s third-party Internet Gaming service providers and its employees who need this information to carry out their duties related to managing the Self-Exclusion program. I confirm that the following personal information about me is valid and up to date. Please verify or edit your personal information below. Your personal information Name Date of Birth Address Primary phone number Mobile phone number Banking information Last four digits of Account Number Have you ever been self-excluded from any casino or slots facility in Ontario? Yes No Request to be Placed on the Internet Gaming Self-Exclusion List and Release Page 4 of 5

5 Consent for release of personal information Please provide your consent as follows: I consent for OLG to release my personal contact information to third-party researchers for the purpose of requesting my participation in gambling and/or problem gambling research. I understand that, from time to time, I may be contacted by such third-party research agencies to ask for my permission to participate in research and associated studies; however, I have no obligation to do so. I DO NOT give my consent for OLG to release my personal contact information to third-party researchers for the purpose of requesting my participation in gambling and/or problem gambling research. I have read this Request to be Placed on the Internet Gaming Self-Exclusion List and Release and understand all of its terms. I agree to these terms voluntarily and with full knowledge of their consequences and significance and hereby request to be placed on the OLG Internet Gaming Self-Exclusion List. Name Date of Enrollment Request to be Placed on the Internet Gaming Self-Exclusion List and Release Page 5 of 5