GRILL FLAME VOLUNTEER CONSENT STATEMENT

CIA-STARGATE

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The document is a volunteer consent statement for participation in the GRILL FLAME project, a Department of Defense project exploring military applications of psychic abilities. The document outlines the nature, duration, purposes, and expected benefits of the program, as well as the methods and means by which it will be conducted. It also includes information about any potential inconveniences, hazards, discomforts, risks, or other effects on the participant's health and well-being. The document states that the participant has the right to revoke their consent and withdraw from the study at any time, but may be asked to undergo further examinations if deemed necessary by a qualified physician. The document also includes requirements for the explanation of experiments, procedures, and alternative measures to protect the participant's health.

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Body:  Approved For Release 2001/
 P96-00789 R002100150015-7
 GRILL FLAME VOLUNTEER CQNSENT STATEMENT
 SGFOIA3
 I     /    R V 19 N dJ  ~1.       /9 (~ t09 SSAN
 having attained by eighteenth (,18th) birthday an  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 fol-
 lowing items have been explained to me by
 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;
 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 neces-
 sary for my health or well-being.
 (NAME)                        (DATE)
 I was present during the explanation referred to above,  as
 well as the volunteer's opportunity for questions,  and hereby
 witness his signature.   I am not involved in the GRILL FLAME
 program in any way.
 (NAME)
 (DATE)
 Approved For Release 2001/          P96-00789R002100150015-7
 Approved For Release 2001/030          96-00789R
 ET "T
 D02100150015-7
 1.   Explanation-of experiments,  including nat
 purpose and expected benefits.    Must include
 no hypnosis, drugs, or other psychopharmacolo
 or treatment of research subjects by sublimin
 or other means of stimulation unknown to them
 in this program.   (Standard)
 re, duration,
 tatement that
 ical agents,
 1-technologies
 are -n rolved--1
 2.   Explanation of procedures,  including meth d.s and means
 by which conducted and an indication of those methods and
 means that are experimental.
 3.   Description of reasonably expected inconv niences, hazards,
 discomfort,  risks, or other effects.   (Standa d)
 4.   Description of any alternative procedures that might be
 employed to protect further the subject healt  .   If none,  so
 state.   (Standard)
 5.   Description of alternative advantages to
 (Standard)
 6.   Status of volunteer's health as determine
 Include EKG results.
 Eff
 Approved For Release   'I Jffi/
 ,   F P96a-C 9