VOLUNTARY EXPERIMENTATION INTAKE

01

identification

full name / registered designation *

alias, epithet, or previous designation

species / spiritual classification *

age / estimated age

pronouns

02

institutional information

occupation *

affiliation

rank / seated position

place of residence

03

spiritual profile

known spiritual abilities, techniques, or anomalous properties

zanpakutō

previous artificial modifications

04

physical condition

injuries, chronic defects, allergies, illnesses, or structural abnormalities

known regenerative capacity

05

experimental suitability

preferences are collected for statistical purposes and do not constitute restrictions upon the laboratory.

areas of volunteered participation

prototype medicines, poisons, antidotes, and stimulantsreiatsu suppression, amplification, and destabilizationanatomical and physiological observationexperimental prosthetics and artificial organszanpakutō / soul interaction studiessensory deprivation or alterationcontainment equipment and restraint testingwhatever captain kurotsuchi considers useful

reason for volunteering

procedures you would prefer to avoid

06

post-procedure arrangements

individual to notify in the event of irreversible complications

disposition of remains

07

authorization

by submitting this application, i certify that the information above is substantially accurate to the best of my present anatomical knowledge.

i understand that experimental procedures may produce temporary, permanent, spiritually persistent, cosmetically objectionable, or presently unnamed consequences.

i further acknowledge that the research and development institute reserves all rights to observations, measurements, tissue samples, spiritual residue, and discoveries obtained during the trial.

signature / spiritual imprint *