1. Personal Responsibility
I, ___________________________, recognize, acknowledge and agree that I am exclusively responsible for my present and future condition in life and for the choices and decisions I make affecting my life. With that in mind, and solely of my own volition and in the independent exercise of my own free will, I am voluntarily signing and submitting to CHURCH OF SCIENTOLOGY ___________________________ (hereinafter "the Church") this RELIGIOUS SERVICES ENROLLMENT APPLICATION, AGREEMENT AND GENERAL RELEASE (hereinafter "this Contract") so that, upon its acceptance by the Church, I may participate in Religious Services of the Scientology religion.
2. Religious Services Description
The Religious Services that may be provided to me by the Church include, but are not limited to: auditing, training, courses, seminars, workshops, and other spiritual counseling services based on the religious scriptures and teachings of L. Ron Hubbard.
3. Ecclesiastical Records
I acknowledge that the Church may create and maintain ecclesiastical records, including Preclear (PC) folders, worksheets, and other documents related to my spiritual progress. These records are the exclusive property of the Church and are governed by ecclesiastical law and clergyman-penitent privilege.
4. Confidentiality
I agree to maintain absolute confidentiality regarding all aspects of Scientology religious technology, ecclesiastical procedures, and any confidential information disclosed to me during religious services.
5. Waiver of Access Rights
I voluntarily and irrevocably waive any and all rights to access, view, copy, or possess my ecclesiastical records, understanding that this waiver is required by religious doctrine for the protection of my spiritual progress and the integrity of the ecclesiastical process.
6. General Release
In consideration for the Church providing me with religious services, I hereby release, waive, discharge, and covenant not to sue the Church, its officers, directors, employees, agents, successors, and assigns from any and all liability, claims, demands, actions, or causes of action arising out of or related to my participation in religious services.
7. Acknowledgment of Religious Nature
I acknowledge and agree that Scientology is a bona fide religion and that all services provided by the Church are exclusively religious in nature, based on the religious scriptures of L. Ron Hubbard as published with the Scientology religious symbols.
8. Legal Effect
This Contract constitutes the entire agreement between me and the Church regarding my participation in religious services and supersedes all prior agreements, whether written or oral.
Signature Section
Dated this ___ day of _______________, 20___.
_______________________________
(Signature)
_______________________________
(Printed Full Name)
_______________________________
(Home Address)
_______________________________
(City, State, ZIP Code)
_______________________________
(Telephone Number)
Parent/Guardian Signature (if applicant is under 18):
_______________________________
(Signature of Parent or Guardian)
_______________________________
(Printed Full Name)
_______________________________
(Relationship to Applicant)
_______________________________
(Home Address)
Witness:
_______________________________
(Signature of Witness)
_______________________________
(Printed Full Name)
_______________________________
(Home Address)
Church Acceptance:
CHURCH OF SCIENTOLOGY OF ___________________________
By: _______________________________
(Authorized Representative)
_______________________________
(Printed Name and Title)
Date of Acceptance: ___________________________