GRILL FLAME VOLUNTEER CONSENT STATEMENT

• Document Type: CREST
• Collection: STARGATE
• Document Number (FOIA) /ESDN (CREST): CIA-RDP96-00789R002100150013-9
• Release Decision: RIPPUB
• Original Classification: S
• Document Page Count: 2
• Document Creation Date: November 4, 2016
• Document Release Date: December 4, 1998
• Sequence Number: 13
• Publication Date: February 28, 1980
• Content Type: CONT

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
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 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
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