Self Exclusion Form

By completing this form, you will be excluded from gambling related products and activities from Bristol & Weston Hospitals Charity which will include all gambling related communications. Your self-exclusion from Bristol & Weston Hospitals Charity Weekly Lottery is automatically a permanent arrangement and will be available with immediate effect. Should you wish to start playing again we would need your request in writing. However, there is a minimum period of self-exclusion of 6 months, and by Law we cannot remove your self-exclusion status before 6 months has lapsed. Should you have any current entries, these will be cancelled, and money already allocated to future draws will be refunded to you.

For more information about excluding yourself from our lottery, please contact us at [email protected] or 0117 927 7120.

If you would like more information or help and advice from a gambling support agency, please visit www.gambleaware.co.uk.

First name: (required)

Last name: (required)

Email address: (required)

Date of birth: (required)

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Address line 2:

Town/City: (required)

County: (required)

Postcode: (required)

We promise to respect any personal data you share with us and keep it safe. We aim to be clear we are collecting your data and not do anything with your data that you would not reasonably expect.

You can read our full privacy policy here: www.bwhospitalscharity.org.uk/privacy-policy

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