The following form is for use when students audit minors.

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

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

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

.................................................................................................................................

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

...................................................... to be audited on Standard Dianetics Processes

by ........................................................................................ (Auditor) and that I understand that the Auditor is a student of Dianetics, which is known to be Pastoral Counseling, a religious guide intended to make happy human beings and not treating or diagnosing any medical ailments of body or mind whatsoever.

Date ................................................

Signature: .............................................................................

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

.......................................................................................................................................................