HUBBARD DIANETICS FOUNDATION
     ENROLLMENT APPLICATION/AGREEMENT AND GENERAL RELEASE
 

     I, _____________, HEREBY ACKNOWLEDGE that I am voluntarily applying to participate in the RELIGIOUS SERVICE(S)

     Known as __________________, (Hereinafter referred to as the Service.)

     In exchange for being permitted to participate in the service, I acknowledge and agree as follows:

     Scientology has been represented to me as an applied religious philosophy and as a religion recognized as such all over the world, devoted to the study and handling of the human spirit in relationship to itself, universes and other life. The word Scientology comes from the Latin "scio" meaning knowing in the fullest sense of the word, and the Greek "logos," meaning "study of." Dianetics® spiritual healing technology is part of the Scientology® religion and is the study of what the soul is doing to the body. The word "dia," through, and "nous," soul, thus "through soul."

     The American author and philosopher L.Ron Hubbard ("LRH" hereinafter) is the founder of the Scientology religion. His writings and recorded spoken words on the subjects of Scientology and Dianetics are a record of his observations and research into the human spirit and condition. These writings contain a guide intended to assist persons to become more aware of themselves as persons, restoring respect for self and others, and not for treating or diagnosing ailments of the body, nor for engaging in teaching or practicing medical arts or sciences. (If you have come here to be cured of a physical illness, see the registrar and so inform her so that she can arrange for a competent medical examination and treatment. When you are physically well, you can begin Scientology training and processing on your road to total freedom).

     The writings of LRH are presented as a part of the record of his research and should be construed only as a written report of such research and not as a statement of claims by the Foundation or by LRH. None of the organizations which espouse, present, propagate or practice Dianetics® spiritual healing technology makes any claim that the nature or purpose of Dianetics, or the writings of LRH, is contrary to this description or that the application of any of this or any other Dianetics practices will have any particular effect on any particular person. Thus the Foundation makes no claims as to the results which may be forthcoming from the service.

     Dianetics technology is an organized science of thought built on definite statements of natural law and produces a condition of ability and rationality for an individual. Dianetics techniques give a complete insight into the full potentialities of the mind, result in greater self-confidence and assist the individual in accomplishing his goals in life. The attainment of the benefits and goals of Dianetics requires each individuals's dedicated participation, as through his own efforts can he achieve these. Accordingly, the Foundation makes no claims as to the potential benefits which may be experienced by an individual from participation in the Service.

     The many Scientology churches, Missions and Organizations all over the world are each totally independant of one another, connected only by ecclesiastical bonds. Accordingly, the Service is being offered under the exclusive supervision and control of the above-named church.

     The service may include the use of a religious artifact known as the "E-meter," for the primary purpose of locating and resolving problems and difficulties which are spiritual in nature. I understand that by itself the E-meter does nothing, but serves as only a guide to ministers of the Church to assist parishioners in locating areas of spiritual distress or travail, and that is not intended or effective for the diagnosis, treatment or prevention of any disease, or for the improvement of health or any bodily function.

     In connection with the Service, the Church may compile a folder containing its notations of my spiritual progress, known as a "Preclear folder" (PC Folder), as well as other ecclesiastical files containing notations regarding my spiritual progress. The contents of the folders are kept confidential from persons who lack the ecclesiastical authority to gain access to such documents, including the person whom the files concern, and are subject to the priest-penitent privilege. I understand that as a condition of being accepted for participation in the Service, I am giving up any and all rights of ownership, possesion and control, copying and viewing the PC folder and other files concerning myself, both with respect to the files themselves and the information contained therein.

     I understand and acknowledge that because of Constitutional prohibitions which forbid governmental interference with religious services or dispute resolution procedures, that in the event I have any dispute with the Church which cannot be resolved informally by direct communication, resolution of that dispute may be pursued solely through the internal procedures of the Church's Ethics, Justice and Binding Religious Arbitration system.

     Moreover, I hereby expressly agree that any contoversy arising under this application/agreement or in connection with my participation in the Service shall be resolved by Binding Religious Arbitration. I understand and acknowledge that the Church's religious dispute resolution procedure includes application to senior ecclesiastical bodies, including, as necessary, final submission of the dispute to the International Justice Chief of the Mother Church - Church of Scientology International - ("IJC") or his designate...

     Within fifteen (15) days after receiving the request for arbitration, the Church shall designate an arbitrator. If the Church has not designated an arbitrator within fifteen (15) days, then the IJC shall designate the second arbitrator.

     The two arbitrators so designated shall select a third arbitrator within fifteen (15) days after the designation of the second arbitrator. If the arbitrators are unable to designate a third arbitrator within the fifteen (15) day period, then the IJC shall choose such arbitrator. Consistent with the intent that the arbitration be conducted in accordance with Scientology principles of justice and fairness, all arbitrators shall be Scientologists in good standing with the Mother Church.

     IN ACCORDANCE WITH THE RELIGIOUS NATURE OF THE SERVICES TO BE PROVIDED, I ACKNOWLEDGE, UNDERSTAND AND AGREE THAT IN NO EVENT SHALL ANY DISPUTE, CLAIM OR CONTROVERSY ARISING OUT OF MY PARTICIPATION IN THE SERVICE BE SUBMITTED TO A COURT FOR JUDICIAL DETERMINATION. MOREOVER, I UNDERSTAND AND AGREE THAT BY SIGNING AND SUBMITTING THIS APPLICATION/AGREEMENT, I AM WAIVING ANY RIGHT WHICH I MAY HAVE TO HAVE DISPUTES HEREUNDER DECIDED IN A COURT OF LAW, BEFORE A JUDGE OR A JUDGE AND JURY.

     I further understand and acknowledge and agree that the Church is under no duty whatsoever to return any portion of any religious donation received from me. However, I further understand and acknowledge that under certain circumstances provided for in the published policies and procedures of the Claims Verification Board, refunds may be obtained through my strict compliance with those published policies and procedures. I further acknowledge and agree that the refund procedures require my direct participation to the exclusion of any third parties, including, but not limited to, attorneys.

     I understand and acknowledge that I am applying for the Service with the intention of self-improvment and spiritual advancement. Accordingly, before I go on to a further service. it is essential that I am completely satisfied with the results I obtained from my prior service. I further understand and acknowledge (i) that while the Church holds out the possibility of a better life through the adherence to its beliefs and practices, individual spiritual advancement is not always an easy and comfortable task, and (ii) that my success in Scientology ultimately depends on my own ability, strength and determination to overcome the shortcomings and harmful patterns of my past.

     I understand and acknowledge that the Service is designed to give spiritual aid, is not medical treatment, nor is it designed to provide any physical gains. I am also aware that I should not participate in the Service if I have a physical or emotional condition which would be aggravated by participation in the Service or make the Service activities particularly uncomfortable or distressful to me. Knowing this, I am voluntarily participating in the service with knowledge of the general activities involved and I HEREBY AGREE TO ACCEPT ANY AND ALL KNOWN OR UNKNOWN RISKS OF INJURY, LOSS OR DAMAGE.

     I acknowledge that I am making this application to be permitted to participate in the service on my own determinism, recognizing that I am personally responsible for my present and future condition in life, and attest that I have no record of being committed in an institution for mental or emotional disorders, nor do I have a criminal record for a felony offense. I am not connected with any person (such as marital or family ties) of known antagonism to spiritual treatment or Dianetics, nor have I or any member of my immediate family ever threatened to sue, attack, embarrass or attack Dianetics, nor have I or any member of my immediate family been a party to such an attack. I further attest that I am not attempting to investigate Dianetics as a representative of any news media, a governmnent body or other organization, entity or person. Rather, I am applying to participate in the Service to achieve spiritual betterment, and I truly believe that persons can be helped to gain greater understanding and happiness in life, and I am applying honestly and in good faith to derive all possible personal gain from the service.

     This enrollment application for permission to participate in the service will become a legally binding agreement between myself and the Foundation only upon its acceptance by the Foundation. In determining whether to accept this application, the Foundation will rely on the representations and promises which I have made therein.

     AS FURTHER CONSIDERATION for being permitted by the Foundation to participate in the service and use its facilities and other facilities provided for such purpose:

     I, ON BEHALF OF MYSELF AND ON BEHALF OF MY HEIRS, DISTRIBUTEES, LEGAL REPRESENTATIVES AND ASSIGNS, AGREE NOT TO MAKE CLAIMS AGAINST, SUE, ATTACH THE PROPERTY OF, OR PROSECUTE the Foundation, the successors and assigns of L. Ron Hubbard, and any affliated organizations, corporations, associations, partnerships and/or their officers, directors, trustees, agents, servants, successors, heirs, executors or representatives, and/or the owners, managers, employees, agents or representatives of, or associated with any facilities conducting the Service (hereinafter collectively referred to as "the Releasees") for physical, mental or emotional injury or property damage resulting from the negligence or other acts, howsoever caused, of any Releasee or of any employee, agent or contractor of the Foundation, its affliates, or other Releasee, in any way relating to my participation in the Service.

     IN ADDITION, I HEREBY RELEASE AND DISCHARGE THE RELEASEE from all actions, claims or demands I, my Heirs, distributees, guardians, legal representatives or assigns now have or may hereafter have for physical, mental or emotional injury or property damage resulting in any way from my participation in the Service.

     I FURTHER AGREE TO INDEMNIFY AND SAVE AND HOLD HARMLESS THE RELEASEE and each of them from any loss, liability, damage or cost they may incur due to my participation in the Service and/or due to my presence or action in or about the Foundation premises or the facilities provided for the Service.

     I further agree and understand that should any provision or provisions of this Agreement be, for any reason, unenforceable, the balance shall nonetheless be of full force and effect.

     I HAVE CAREFULLY READ THIS APPLICATION/AGREEMENT AND GENERAL RELEASE AND FULLY UNDERSTAND ITS CONTENTS AND CONSEQUENCE. I AM AWARE THAT BY SIGNING BELOW, I AM FOREVER GIVING UP MY RIGHT TO SUE THE FOUNDATION, ITS STAFF AND/OR OTHER RELATED ORGANIZATIONS FOR ANY INJURY OR DAMAGE SUFFERED IN ANY WAY CONNECTED WITH THE SERVICE ACTIVITIES.

     I sign this APPLICATION/AGREEMENT AND GENERAL RELEASE of my own free will on this ___ day of ___, 199___, intending to be legally bound hereby, and request that I be permitted to participate in the SPIRITUAL HEALING SERVICE(S) named above

     Signature
     Guardian Signature

     Print full name

     Home street address
     Witness signature plus date
     City and State/Country

     Having reviewed the above application, the Foundation, in reliance and conditioned on the truthful representations and agreements made therein, on this ____ day of _________, 199___, accepts the applicant for participation in the above-named Spiritual Healing Service(s)

     HUBBARD® DIANETICS FOUNDATION OF
     NAME
     TITLE
     SIGNATURE


See also: Sea Org contract.

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