Church of Scientology of
________________________________
(Name)
(hereinafter referred to as "the Church")
Introductory Religious Service
Enrollment Application,
Agreement and General Release
I ________________________________, recognize, acknowledge and agree that I am exclusively responsible for all my physical and mental conditions in my 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 the Church of Scientology of ___________________ (hereinafter 'the Church") this Religion Service Enrollment Application, Agreement and General Release (hereinafter called "Agreement').
By signing this agreement I recognize, acknowledge and agree that:
- Scientology is a religion and all the services and activities of the Scientology religion are exclusively religious in nature and intended for the betterment and well being of mankind. Dianetics spiritual healing technology is part of the Scientology religion and is the study of what the soul is doing to the body.
- The Founder of Scientology is L. Ron Hubbard. The writings and the recorded spoken words of Mr. Hubbard on the subject of Scientology present a guide intended to assist persons to become aware of themselves as persons, restoring trust and respect for self and others. They are not a statement of claims by the Church, by any other Scientology Organizations, or by Mr. Hubbard.
- The Church makes no claim that I will attain any particular result and shall not be responsible for any personal opinion or belief of any individual staff member for any particular result or effect that may be forthcoming due to my participation in the services.
- The Church and all other Scientology Organizations are separate distinct legal bodies and each is separately responsible for its own management, corporate, ecclesiastical and legal affairs.
- The services provided by the Church are directed towards the well being of mankind. It is done entirely by imparting spiritual knowledge and not through any means of medical assistance.
- The services provided by the Church are not intended and are not used for diagnosing ailments of the body or for engaging in the teaching or practice of any medical arts or sciences. I am not participating in the services of the Church in order to get cured of any physical illness, ailment or condition.
- I shall participate in the services of the Church only if my physical and medical conditions are fit for it and I shall be personally responsible for any injury, loss or damage that may result from such participation.
- I shall proceed in further services provided by the Church only when I feel satisfied with my prior experience.
- Scientology holds out the possibility of a better life and that my success in it depends upon my own ability, strength and determination to overcome the shortcomings and harmful patterns of my past.
- Any donation or offerings once made be me to any Scientology Organization in any manner will belong to that Organization and that the Church is under no obligation whatsoever to return any portion of any religious donation I make. However, I have read Scientology Policy Directive 13 March 1996, Return of Donations, and understand that under certain circumstances a return of donations may be obtained but only through my strict compliance with applicable Church policy.
- In connection with my participation in the Scientology services, the Church may compile folders, files, or documents containing notations and records regarding my spiritual progress. These documents are confidential and shall be the sole property of the Church of Scientology International and I do hereby unconditionally and irrevocably forever abandon, surrender, waive and relinquish without limitation any and all rights of ownership, possession, custody, control, access, copying and viewing of such confidential files documents. The Church of Scientology International shall have the absolute power and right to move physically such confidential documents, anywhere.
- Any personal spiritual progress will be directed by a Case Supervisor who will determine which Scientology services and courses are appropriate for my personal spiritual progress.
- I do hereby unconditionally and irrevocably, forever abandon, surrender, waive and relinquish my right to sue or otherwise seek legal recourse with respect to any dispute, claim against or controversy arising with the Church and any other Scientology Organization and all persons employed by any such entity.
- I do hereby unconditionally and irrevocably, forever abandon, surrender, waive and relinquish my right to sue or otherwise seek legal recourse with respect to any dispute, claim against or controversy arising with the Church and any other Scientology Organization and all persons employed by any such entity.
- I do hereby agree that any dispute, claim against or controversy arising with the Church and any other Scientology Organization and all persons employed by any such entity shall be resolved by binding arbitration under the rules of the American Arbitration Association.
- I do hereby agree that any dispute, claim against or controversy arising with the Church and any other Scientology Organization and all persons employed by any such entity shall be resolved by binding arbitration under the rules of the American Arbitration Association.
- I do hereby agree that any dispute, claim against or controversy arising with the Church and any other Scientology Organization and all persons employed by any such entity shall be resolved by binding arbitration under the rules of the American Arbitration Association.
- I do hereby agree that any dispute, claim against or controversy arising with the Church and any other Scientology Organization and all persons employed by any such entity shall be resolved by binding arbitration under the rules of the American Arbitration Association.
- I do hereby agree that any dispute, claim against or controversy arising with the Church and any other Scientology Organization and all persons employed by any such entity shall be resolved by binding arbitration under the rules of the American Arbitration Association.
I understand that I am applying for enrollment in Scientology services of my own free will and that I am not being coerced or pressured in any way to make this application. I have read and understand this Agreement and Release and I agree to be bound by its terms. I understand that this Agreement and Release is a binding contract between myself and the Church.
I understand that I am applying for enrollment in Scientology services of my own free will and that I am not being coerced or pressured in any way to make this application. I have read and understand this Agreement and Release and I agree to be bound by its terms. I understand that this Agreement and Release is a binding contract between myself and the Church.
I understand that I am applying for enrollment in Scientology services of my own free will and that I am not being coerced or pressured in any way to make this application. I have read and understand this Agreement and Release and I agree to be bound by its terms. I understand that this Agreement and Release is a binding contract between myself and the Church.
APPLICANT:
Signature:_____________________________
Date:_______________
Print Name:_____________________________
PARENT OR GUARDIAN (if applicant is a minor):
Signature:_____________________________ Date:_______________
Print Name:_____________________________
WITNESS:
Signature:_____________________________ Date:_______________
Print Name:_____________________________
CHURCH REPRESENTATIVE:
The Church of Scientology International hereby acknowledges that it has received the above Agreement and Release and that it will rely upon the statements made herein.
Signature:_____________________________ Date:_______________
Print Name:_____________________________