Approved For Release
GRILL FLAME VOLUNTEER CONSENT STATEMENT
RDP96-00789R0021 001 5001 3-9
SGFOIA3
SSAN
having attained my eighteenth
(18th)
birthday and otherwise having full
capacity to consent,
do hereby volunteer
to participate
in GRILL FLAME,
a DOD
project to determine possible military applications of
inherent psychic
abilities.
The following
items have been explained
to me
by L TC
A /? /f
1/
WdTT
_ and are set forth on the reverse side of this Agreement,
'
which
I have
initialed:
a.
The nature,
duration,
purposes,
and expected benefits of the program
in which
I will be participating;
b.
The methods and means by which the program
is
to be conducted;
any
methods and means
that are experimental will be
identified as such;
c.
The
inconveniences,
hazards,
discomforts,
risks
or other
effects on
my health or person which may possibly come from my participation
in the
program;
and
d.
The alternative procedures,
if
any,
that might be employed to protect
further my health and well-being.
I
have been given an opportunity to ask
questions concerning
this project and any such questions have been answered
to my full and complete satisfaction.
I understand that
I may at any time
during
the course of
this project revoke my consent and withdraw from the
study without prejudice;
however,
I may be requested to undergo certain
further
examinations,
if,
in the opinion of
a qualified physician,
such
examinations are necessary for my health
or well-being.
(DATE)
I was present during
the explanation referred to above,
as well as the
volunteer's opportunity for questions,
and hereby witness his/her
signature.
I am not
a participant
in
the GRILL FLAME program.
(NAME)
(DATE)
Approved For^
ig;
-00789R0021 001 5001 3-9
Approved For Release 2001
-OO789R0O21 001 5001 3-9
ion,
purpose and
1.
Explanation of experiments,
including nature,
durat
expected benefits.
Must
include statement that no hypnosis,
drugs,
or other
psychopharmacological agents,
or treatment of research
s
technologies
or
other
means, of stimulation unknown to th4
this program.
(Standard)
Objects by subliminal
m,
are
involved
in
2.
Explanation of procedures,
including methods and
meai
and
an
indication
of
those methods and
mfeans
that are
ex;
hs
by which conducted
ber imental.
3.
Description of reasonably expected. inconveniences ,
hazards,
discomfort,
risks,
or other
effects.
(Standard).^/
Description of any alternative procedures
that might
te$t
further
the subject's health.
If none,
so state.
5.
Description of alternative advantages
to volunteer.
, be employed to pro-
(Standard)
6.
Status of volunteer's health as determined by a phys
result s
7.
You may lose the esteem or respect from certain
colljs
nature of GRILL FLAME activities since some may consider
such activities as
indicating
a belief
in
the
"occult or
knowledge,
no-one has suffered such career damage from a
activity,
but the potential
for
such
is brought to your
tcian.
Include EKG
8.
I understand that as
a participant
in
the GRILL FLAMp
to believe that
I have
the ability to use "psychic power
fit
in risk-taking situations such as
"games
of chance"
ment.
Any such assumption on my part
is my sole respons
FLAME program
in no way sanctions such an assumption.
Sj
have served as subjects
in this kind of experiment have
assumptions
to their apparent disadvantage.
Thus,
the
may come to believe
that you have
a power
that you do no
advised of
this
risk and warned that you assume responsi
assumptions which you make about your personal powers or
9.
Questions posed by volunteer and answers
NOTE:
Volunteer will
initial end of each of above paragraphs
(Standard)
agues because of
the
participation
in
magical."
To our
GRJLL FLAME-r elated
Attention,
program,
I may come
is"
for personal pro-
or
speculative
invest
ibility.
The GRILL
:pme
individuals who
acted on such
isk exists
that you
it possess.
You are
bility for
any
*
capabilities - /f
Approved For Relea
001 5001 3-9