CIA-RDP96-00789R002100150015-7

Approved For Release 2001/03/07 001A-RDP96-00789R002100150015-7
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SGFOIA3
GRILL FLAME VOLUNTEER CONSENT STATEMENT
I,
· FERNAND'A. GAUVIN
SSAN
having attained by 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 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.
Fernanda Saucein
(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 2001/03/07 - CIA RDP96-00789R002100150015-7
SECRET

Approved For Release 2001/03@ _: (CD-RDP96-00789R002100150015-7
1. Explanation of experiments, including nature, duration,
purpose and expected benefits. Must include statement that
no hypnosis, drugs, or other psychopharmacological agents,
or treatment of research subjects by subliminal technologies
or other means of stimulation unknown to them, are involved v=d
in this program. (Standard)
2. Explanation of procedures, including methods and means
by which conducted and an indication of those methods and
means that are experimental.
3. Description of reasonably expected inconveniences, hazards,
discomfort, risks, or other effects. (Standard)
4. Description of any alternative procedures
that might be
employed to protect further the subject health. If none, so
state.
(Standard)
5.
Description of alternative advantages to volunteer.
( Standard)
6.
Status of volunteer's health as determined by a physician.
Include EKG results.
7.
Questions posed by volunteer and answers.
Note:
Volunteer will initial end of each of
above paragraphs.
...
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Approved For Release 800103/87c CIA-RDP96-00789R002100150015-7
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