Section 1800.EXHIBIT A Youth Participant Consent Form

Name

Date of birth

Date of birth documentation: (require youth participant to produce and attach a copy of some legal proof of age)

Birth certificate	passport	driver's license

Instructions: Carefully read each line below and initial each line. Please ask questions about anything you do not completely understand. Your signature indicates that you understand and are willing to abide by all the terms of this agreement.

1. I understand that the purpose of the compliance check operation is to assess the compliance with gambling laws by attempting to gamble at licensed video gaming locations by playing video gaming terminals.

2. I understand and agree that I am not to pursue or participate in any operation relating to alleged gambling violations unless I am under the direct supervision of a law enforcement officer or licensing inspection official.

3. I understand that specific information about the unannounced compliance checks is confidential and agree that I will not discuss plans, dates, times, outcomes, or details of specific inspections, including but not limited to licensed video gaming locations, nor the identify or description of law enforcement personnel working in plain clothes, unless directed by officials of the Illinois Gaming Board or pursuant to legal proceedings.

4. I agree not to violate any laws or commit any crimes while participating in unannounced compliance checks.

5. I understand that if I violate any laws, except the one from which I am granted immunity, I may be responsible for those violations.

6. I agree to relinquish all gambling vouchers generated as a result of these compliance checks and all unused money to the detail supervisor.

7. I understand that the objective of compliance checks is to test compliance. A successful compliance check is one in which the licensed video gaming location refuses to allow me to participate in gambling, acting in compliance with the law. I must not pressure or coerce an employee, manager or owner of a licensed video gaming location into allowing me to gamble at the location.

8. I agree to be completely truthful when reporting what happened during each compliance check.

9. I have participated in orientation provided by the Illinois Gaming Board and I agree to adhere to the protocol explained in that orientation.

Youth's name (print)

Youth's signature

Date

Witness
(Illinois Gaming Board)
Date

(Source: Added at 44 Ill. Reg. 11134, effective June 22, 2020)