The following form must be used when a minor requires any service.

This form is to be filled in by the parent or guardian of the minor concerned and is a prerequisite before any Dianetic or Scientology processing, testing or train­ing can be undertaken.

Parent or Guardian Assent to Dianetic or Scientology Processing, Testing or Training.

I...........................................................................................................

of..........................................................................................................

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do hereby attest that I give my full consent for my child/ward …............................................

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...................................................... to be tested, audited or trained in the..............

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Scientology Organization and that I understand that all auditing received will be on the Standard Dianetics or Scientology processes administered by an Auditor who is a student of Scientology, and that all training administered will be Standard training for that particular course or level.

I further understand that Scientology is known to be a spiritual and religious guide intended to make persons more aware of themselves as spiritual beings and not treating or diagnosing any human ailments of body or mind whatsoever.

Date:................................................................. Signature:............................

Address......................................................................................................

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