Release and Waiver Form
NB: Not Number 4 below. This you will not find on a refund form from the church.
Relating to a Refund from the corporate company known as the Church of Spiritual Technology or it's companies and churches such as the Religious Technology Centre, Church of Scientology
International, or any of its affiliates, corporations management organizations or groups.
I_________________________________________________________________________of___________________________________________________and being no longer in agreement with the current activities of the Management of Church of Scientology, have requested a refund of donations for services that I have made to the following organization of the above __________________________________________
Do hereby declare:
1. In exchange for and on receipt of the refund of $............. I release and waive all claims for any monies paid to any Church of Scientology for any services, whether taken or not.
2. I understand that payment of the refund of $............. and signature of this release and waiver signifies settlement of the refund claim that made against the Church of Scientology and does
not constitute an admission by any of the released parties of any wrongdoing and that such released parties expressly deny the validity of such claims.
3. I fully understand and agree that I will not again obtain spiritual Counseling or training from any Scientology churches, missions or other Scientology organization this lifetime owned and
operated by or under the banner of the Religious Technology Centre or the Church of Spiritual Technology.
4. I retain the right to the religious practice and freedom and belief of the religion and or philosophy of my choosing including the rituals and practices associated thereby, and this
waiver does not deny me such rights as granted by the law of the country to which I am native and or are residing in.
5. This release and waiver does not deny or remove any legal rights I have or may have in the future as such may be granted by the laws and statutes of the country to which I am native and
or are residing in or will reside in the future.
6. I acknowledge and affirm that I have carefully read and I understand this release and waiver and that I sign it as a deed of my own free will without any duress from the released parties or
7. In the event any provision hereof be unenforceable, such provision shall not affect the enforceability of any other provision hereof.
In WITNESS whereof I set my hand this ______ day of ________________20.....
Notary Witness: ______ day of __________________20....
SIGNED as a Deed by the Said: of Scientology for requested services.