GRILL FLAME VOLUNTEER CONSENT STATEMENT

• Document Type: CREST
• Collection: STARGATE
• Document Number (FOIA) /ESDN (CREST): CIA-RDP96-00789R002100150015-7
• Release Decision: RIPPUB
• Original Classification: S
• Document Page Count: 2
• Document Creation Date: November 4, 2016
• Document Release Date: December 4, 1998
• Sequence Number: 15
• Publication Date: October 4, 1979
• Content Type: CONT

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