HUBBARD DIANETICS FOUNDATION
ENROLLMENT APPLICATION/AGREEMENT AND GENERAL
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
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
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
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
See also: Sea Org contract.