GRILL FLAME VOLUNTEER CONSENT STATEMENT

CIA-STARGATE

PDF Scan: PDF

Open AI Summary

The document is a consent statement for a volunteer participating in the GRILL FLAME program, which is a DOD project to determine military applications of psychic abilities. The document outlines the explanations provided to the volunteer regarding the nature, duration, purposes, and expected benefits of the program, as well as the methods and means by which the program is conducted. The document also discusses the potential inconveniences, hazards, discomforts, risks, or other effects that may arise from the volunteer's participation, and any alternative procedures that could be employed to protect their health. It mentions that the volunteer has the right to revoke consent at any time, but may be required to undergo further examinations if deemed necessary for their health. The document also highlights the risk of losing esteem or respect from colleagues due to the nature of the program's activities, and warns against making assumptions about personal psychic powers or capabilities. The volunteer has had the opportunity to ask questions, and their initials can be found at the end of each paragraph.

Text

Body:  Approved For Releas        /RDP96-00789R002100150013-9
 GRILL FLAME VOLUNTEER CONSENT STATEMENT
 SGFOIA3
 I             1             _             Al                  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 T( /11",tj t?i
 8   L414 #4477-       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, T 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.
 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)
 SECRET
 Approved For RRelease 70 0~I?0 10-1 : dl rfi   `6-00789R002100150013-9
 Approved For Release 2001  /,.        9-00789R 02100150013-9
 1.   Explanation of experiments, including nature, durati n, purpose and
 expected benefits.  Must include statement that no hypno is, drugs, or other
 psychopharmacological agents, or treatment of research subjects by subliminal
 technologies or other mean  of stimulation unknown to th m, are involved in
 this program.  (Standard
 2.   Explanation of procedures, including methods and mea s by which conducted
 and an indication of those methods and means that are ex erimental.
 44-
 3.                      Description of reasonably expectedrinconveniences, hzards, discomfort,
 risks, or other effects.   (Standard)
 4.G Description of any alternative procedures that might be employed to pro-
 te$t further the subject's health.   If none, so state.   rStandard)
 5.   Description of alternative advantages to volunteer.   (Standard)/
 6.   Status of volunteer's health as determined by a physcian.   Include EKG
 results. 6
 7.   You may lose the esteem or respect from certain coil agues because of the
 nature of GRILL FLAME activities since some may consider participation in
 such activities as indicating a belief in the "occult or magical."  To our
 knowledge, no-one has suffered such career damage from a GRILL FLAME related
 activity, but the potential for such is brought to your attention.
 8.   I understand that as a participant iri the GRILL FLAM  program, I may come % to believe that I have the ability to use "psychic powerE;" for personal pro-
 fit in risk-taking situations such as "games of chance"   r speculative invest-
 ment.  Any such assumption on my part is my sole responsibility.   The GRILL
 FLAME program in no way sanctions such an assumption.   S me individuals who
 have served as subjects in this kind of experiment have cted on such
 assumptions to their apparent disadvantage.   Thus, the risk exists that you
 may come to believe that you have a power that you do not possess.   You are
 advised of this risk and warned that you assume responsibility for any
 assumptions which you make about your personal powers or capabilities
 9.   Questions posed by volunteer and answers
 NOTE:   Volunteer will initial end of each of above paragraphs.
 ScG~ET
 Approved For Relea?b'r26 1W&E: L9 -b  6N8?'f    02100150013-9