Informed Consent Form.pdf

Ordo Templi Orientis U. S. A.

Informed Consent, Release and Indemnity

I, ___________________________________________ , desire to participate voluntarily in the activities of Ordo

Templi Orientis. I acknowledge that Ordo Templi Orientis provides activities and ceremonies of a religious

nature for men and women, some of which are private initiation ceremonies with confidential proceedings. I

acknowledge that the intent of all of the activities of Ordo Templi Orientis is to provide positive and enriching

experiences for all who participate. With my signature below, I signify my acceptance of the rules and policies

of Ordo Templi Orientis U.S.A. and the decisions of its officers and governing bodies.

I understand that every attempt is made to minimize the existing risks that are inherent in the nature of some of

the activities involved through the use of proper equipment, safe facilities and sound safety practices. However,

I also understand that these risks cannot be eliminated completely.

I realize that as a participant in the initiation ceremonies and other activities of Ordo Templi Orientis I could

possibly incur bodily injuries. Due to the nature of these activities, injuries may be minor to fatal in nature.

Some specific bodily injuries that are not uncommon to similar types of activities are listed below:

Stoppage of breathing; heart failure; stroke; spine and neck injuries (either of which could result in paralysis);

broken bones; cuts and lacerations; bleeding; eye injuries (which could result in blindness); convulsion;

unconsciousness; abrasions; fainting; sudden illness; cramps; burns; drowning; and contracting of communicable

diseases. In addition, there is a potential for accidents or illness while traveling to and from events.

I also realize that as a participant in the activities of Ordo Templi Orientis I could possibly incur non-bodily

injuries, including, but not limited to: emotional, psychological, and social injuries; and damage to, or loss of,

personal property.

I understand that the lists above are not intended to be inclusive of all injuries that may occur, but rather to inform

me of the type of risks inherent in my participation in the activities of Ordo Templi Orientis, so that I can make

a voluntary choice to participate or not participate.

I hereby affirm that I am voluntarily participating in any or all of the activities of Ordo Templi Orientis with full

knowledge of the potential risks which they present, including risks of bodily, emotional, psychological, and

social injury, property damage, and death, and I hereby agree to accept any and all risks of such bodily,

emotional, psychological, and social injury, property damage, and death.

I agree to release and hold harmless Ordo Templi Orientis, Ordo Templi Orientis U.S.A.,

and their agents, volunteers, officers, employees, and directors, from liability for bodily, emotional,

psychological, and social injury, property damage or death arising from my participation in the activities of Ordo

Templi Orientis. I also agree to maintain confidentiality regarding the proceedings of the private religious

initiation ceremonies of Ordo Templi Orientis and the documents related to those ceremonies. I give this release

and indemnification in exchange for the opportunity for me to participate in the activities of Ordo Templi

Orientis.

I certify that I have read this agreement, that any questions I may have had regarding this agreement have been

answered to my satisfaction, and that I may be giving up legal rights which I may otherwise have. I acknowledge

that I am at least eighteen (18) years of age.

Signed:

Date:

Witness (not an O.T.O. officer or agent):

7/2001