CIA-RDP96-00789R002100150053-5

SECRET
Approved For Release 2001703/07 : CIA-RDP96-00789R002100150053-5
SGFOIA3
GRILL FLAME VOLUNTEER CONSENT STATEMENT
I,
LAWRENCE
J. RickARD
, 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 Frederick H.
ATwater
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, I 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.
Lawrencel . Richard
(NAME)
(DATE)
23 March1981
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.
Hemma
(NAME)
Forman
(DATE)
23 march 1981
CLASSIFIED BY: MSG, DAMI-ISH
REVIEW ON: APRIL 2000
SECRET
NOT RELEASABLE TO FOREIGN NATIONALS.
Approved For Release 2001/03/07 : CIA-RDP96-09789Rb02.15150AME
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Approved For Release 200 13/6 RET.
3/47): CIA-RDP96-00789R002100150053-5
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 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) For
4. Description of any alternative procedures that might be employed to pro-
test further the subject's health. If none, so state.
(Standard) App Pro-
.
5.
Description of alternative advantages to volunteer. (Standard)
6.
Status of volunteer's health as determined by a physician.
FOR
7.
You may lose the esteem or respect from certain colleagues 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 GRELL FLAME-related
activity, but the potential for such is brought to your attention
FOR
8. I understand that as a participant in the GRILL FLAME program, I may come
to believe that I have the ability to use "psychic powers" for personal pro-
fit in risk-taking situations such as "games of chance" or speculative invest-
ment. Any such assumption on my part is my sole responsibility. The GRILL
FLAME program in no way sanctions such an assumption. Some individuals who
have served as subjects in this kind of experiment have acted 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.
SECRET
RELEASABLE TO FOREIGN NATIONALS
Approved For Release 2001/03/07 : CIA-RDP96-00789R002100150053-5