California Cannabis Clones Collective Membership Agreement
COLLECTIVE MEMBERSHIP APPLICATION AND AGREEMENT
California Organic Cannabis Clones Collective
A California Nonprofit Mutual Benefit Collective
By placing your order online you hereby state that you are a qualified patient or a primary caregiver who has received a valid Physician’s Recommendation for the use of Medical Cannabis issued by Medical professional licensed by the Medical Board of California, the California Board
of Podiatric Medicine, or the Osteopathic Medical Board of California in accordance with the California Health and Safety Code § 11362.5 (“Proposition 215” or “Compassionate Use Act of 1996”) and Article 2.5, commencing with Section 11362.7, to Chapter 6 of Division 10 of the California Health and Safety Code (“SB 420”), and that following conditions related to me obtaining above mentioned reccomendation have been met:
A. Physician-Patient Relationship: Documenting that an appropriate physician-patient relationship has been established before recommending cannabis use for medical purposes;
B. Patient Evaluation: Conducting and documenting an appropriate prior medical examination and collecting relevant clinical history;
C. Informed and Shared Decision Making: Providing informed consent, including discussion of side effects;
D. Treatment Agreement: Developing a treatment plan with objectives;
E. Qualifying Conditions: Determining appropriateness and safety of recommendation in accordance with current standards of practice and in compliance with state laws, rules, and regulations which specify qualifying conditions for which a patient may qualify for cannabis for medical purposes;
F. Ongoing Monitoring and Adapting the Treatment Plan: Periodically reviewing the treatment’s efficacy;
G. Consultation and Referral: Consultations and referrals, as necessary;
H. Medical Records: Keeping proper records supporting the decision to recommend the use of medicinal cannabis; and
I. Physician Conflicts of Interest: Avoiding financial conflicts of interest.
I wish to voluntarily join and become a member of California Organic Cannabis Clones Collective (the “Collective”) that facilitates the collaborative efforts of patient and caregiver members – including the allocation of costs and revenues; and agree to follow the terms and conditions as set forth in this agreement.
1. I hereby declare under the penalty of perjury under the laws of the State of California that a California Licensed Medical Doctor recommended or approved my use of Medical Cannabis for an illness for which Cannabis provides relief in accordance with the Compassionate Use Act of 1996 and SB 420.
2. As a member, I hereby appoint and designate the Collective and their representatives, as any true and lawful agents for the limited purpose of assisting me in obtaining my legally prescribed Medical Cannabis. I understand that this means that the Collective will be required to possess, purchase, cultivate, transport and/or distribute medical Cannabis exclusively for Member Qualified Patients or primary caregivers. Therefore, I grant the Collective’s management and other members the limited authority to engage in the afore-mentioned tasks. I further agree and authorize the Collective and its members to use information relating to my status as a qualified Medical Cannabis patient
as use of such information is reasonably necessary for providing my Medical Cannabis for my medical benefit as a qualified Medical Cannabis patient.
3. I authorize the Collective to create and/or assign agency rights in its own name for the purpose of growing Cannabis for my personal medical reasons as well as for the
medical benefit of other members of the Collective.
4. As a member, I understand that the Collective has other members who have joined and agreed to uphold the Collective’s rules and spirit by, among other things, signing a similar Collective Membership Agreement. I hereby authorize the Collective to possess the Medical Cannabis as described under this agreement jointly with other members
I agree that the medical Cannabis possessed by the Collective is at any time the collective property of every patient who has joined the Collective, subject to the Collective’s rules and guidelines established by and for the
Collective for handling Medical Cannabis for the benefit of member patients.
5. I agree to pay to the Collective all personal out-of-pocket expenses and reasonable compensation for services related to providing Medical Cannabis to me and other member patients.
6. I hereby verify that I am a resident of California and my personal Medical Cannabis will not be taken out of the State of California. I further verify and agree that Medical Cannabis shall not be shared, sold, bartered, traded, exchanged or delivered by any means to any other person for medical or other reasons. I understand that diversion of
Medical Cannabis for non-medical purposes and/or to other individuals shall be grounds for the immediate termination of my membership. I also agree to request amounts of medicine strictly for my medical personal use at reasonably necessary intervals apropriate for my medical condition.
7. I agree to possess my original, or true and correct copy, of my Medical Cannabis Physician’s recommendation, when I am on the property used by or belonging to the Collective. I
understand that my failing to do so may result in the termination of membership and that verbal recommendations from physicians will not be accepted.
8. I hereby agree to all future changes of the Collective’s policies as the laws relating to access to Medical Cannabis
might change. I further agree to provide the Collective with all changes relating to my contact information as well as my status as a qualified Medical Cannabis Patient.
9. I understand and agree that adherence to the rules of the Collective is the collective responsibility of all patient members, including myself. I agree that any violation of the terms of this Agreement or any other Collective member rules are grounds for the immediate termination of my membership.
10. I understand and agree that while Medical Cannabis has been authorized by both the people of the State of California and its legislature, and consistently upheld by all California courts, the Federal Government persists in enforcing portions of the Controlled Substances Act, which makes the possession and use of Medical Cannabis a federal crime.
I hereby certified that I have been advised by an authorized agent of the Collective that possession and use of Cannabis for Medical purposes might be grounds for prosecution
under Federal law.
11. I have read over this entire Collective Membership Application and Agreement and certify that I fully agree and understand each paragraph of this agreement and that I have been provided a copy of this Agreement as well as an opportunity for a legal counsel at my own expense.
12. By joining California Organic Cannabis Clones Collective, all patients hereby agree to indemnity and hold harmless California Organic Cannabis Clones Collective from all alleged wrongdoing which may be the fruit of undercover investigations conducted by the patient during their membership with California Organic Cannabis Clones Collective. Any undercover officers, narcotics investigators with or without identification who join the collective and
obtain information about the collectives activities hereby acknowledge to relinquish all information and agree that said information may not be used in a court of law to support any testimonial evidence by the member/officer.
All new patients hereby agree that they have no associations with any law enforcement agencies or entities, and hereby agree not to mislead California Organic Cannabis Clones Collective by failing to disclose that the new member is an undercover officer.
All officers and law enforcement agents who pose as an undercover officer or not, hereby agree that all criminal evidence discovered as a result of the officer being a
member of California Organic Cannabis Clones Collective is irrelevant heresay and inadmissible evidence in either a civil or criminal court setting. For the purposes of this section, all
undercover investigations means all evidence and witness information derived from the undercover officers posing as a new patient, including but not limited to any patients who
may be informants, in witness protection programs, patients possessing fraudulent documents, licenses, or posing as sales reps or producers.
13. The Collective acknowledges and respects the hard work men and women of law enforcement agencies do to better our communities.
This section is intended to protect legal rights and safe access to Medical Cannabis for California Medical Cannabis patients and in no way should be interpreted as a tool to achieve any other goal. Thank you for your service and understanding.
14. I hereby appoint the Collective representative, as designated by collective members, as my proxy to attend the meeting of the members of the Collective on all dates and times, and to represent, vote, execute, consent, waive and otherwise act for the undersigned in the same manner and with the same effect as if the undersigned were personally present at said meeting.
15. By placing an order with the Collective, I hereby affirm that I have read, understand and agree to the terms of the Collective Agreement. Further, I declare under the penalty of perjury that the above is true and correct to the best of my knowledge.
16. I understand that the Collective is democratically controlled and is not organized to make a profit as such, or for their members, as such, but primarily for their members as patrons.
17. I understand that earnings and savings of the business are used for the general welfare of its members or equitably distributed to members in the form of cash, property, credits, or services. Nothing in communications with other collective members, verbal, written or in other way, shape or form should constitute a sale of illegal substances or items. Any monetary reimbursement between collective members represents an amount necessary to cover overhead costs and operating expenses only.
18. I understand that the Collective main product is Phytotherapy plants that have medicinal value and Medical Cannabis offered by the Collective represent less than 5% of available products. For the convenience of the Collective members, Medical Cannabis information is available on the Collective webpage. A list of medicinal plants that can be used in Phytotherapy was provided to me. I was able to make an educated decision validated by a California licensed medical professional to use Medical Cannabis as my primary medicine of choice for my medical condition(s).
MEMBERSHIP RULES AND GUIDELINES
1. All members must be 21 years of age or older and possess a valid California state issued ID or proof of California residency(A mortgage bill, home utility or cell phone bill, vehicle registration card, and bank statement )
2. All members must have a valid California Physician’s recommendation to use Medical Cannabis on file with the Collective at all times and agree that recommendations must be fully verified by an authorized agent of the Collective before any medicine may be provided.
3. All members agree to be respectful of the Collective’s neighbors and adhere to the Collective’s good neighbor guidelines and practices, including, but not limited to, not loitering, littering, using cell phones in an indiscreet manner or playing any loud music in and around the building and parking areas.
4. All members agree to arrive at the Collective’s premises alone, without any friends, family or children waiting in the car, unless a member is disabled and needs to be driven to the premises by another person.
5. All members agree to keep packages with medicine sealed until arriving at their final destination and agree not to bring any backpacks or other bags to the dispensary area. Members acknowledge having been advised that it is a good safety practice to lock any medication in the trunk upon leaving the premises.
6. All members agree not to use or consume any medication in or around the premises or their cars. Members acknowledge being advised that using Cannabis might negatively affect their ability to drive a motor vehicle.
7. Members may not exchange money, share money or split payments for obtaining medication or any other purpose at any time while on the premises.
8. All members agree treat the Collective’s staff, management and other members with dignity and
respect and understand the Collective’s staff and management reserve the right to refuse service to anyone
at any time. Members understand that no acts of violence or threats of violence will be tolerated.
9. All members agree that no smoking, alcohol, illicit drugs or weapons are allowed on the premises at any time.
10. In the event of an emergency, all members must follow the instructions of the Collective’s management and staff.
11. All members understand and agree that maintaining safety, membership rules and adherence to the law are their collective responsibility.
I am either the Patient named above or the Patient’s legally authorized representative.
This release authority applies to any information governed by the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), 42 U.S.C. § 1320(d) and 45 C.F.R. § 160-164, and/or information governed by the California Confidentiality of Medical Information Act (“CMIA”) Cal. Civ. Code § 56-56.37. Specifically, this release authority complies with the valid authorization requirements of 45 C.F.R. § 164.508(c). Pursuant to HIPAA and/or CMIA, I authorize and direct any physician, healthcare professional,
dentist, health plan, hospital, clinic, laboratory, pharmacy, or other covered health care provider, any insurance company, and the Medical Information Bureau, Inc., or other health care clearinghouse that has provided treatment or services to me or that has paid for or is seeking
payment from me for such services, to give, disclose, and release, without restriction, all of my individually identifiable health information and medical records regarding any past, present, or future medical or mental health condition, to include all information relating to the diagnosis and treatment of sexually transmitted diseases, mental illness, and drug or alcohol abuse to the Collective.
The purposes of the usage and disclosure shall include determinations regarding my qualification to use Medical Cannabis and monitoring my health care to protect my legal rights where I reside.
I understand that, with certain exceptions, I have the right to revoke this Authorization at any time. If I want to revoke this Authorization, I must do so in writing. The procedure for how I may revoke this Authorization, as well as the exceptions to my right to revoke will be performed in
accordance with applicable federal law and any applicable policy of my health care provider.
I understand that I may refuse to sign this Authorization. I also understand that my health care provider cannot deny or refuse to provide treatment, payment, and enrollment in a health plan, or eligibility of benefits if I refuse to sign this Authorization. I understand that, once information is
disclosed pursuant to this Authorization, it is possible that it will no longer be protected by applicable federal medical privacy law and could be re-disclosed by the person or agency that receives it; however, I do not authorize such secondary disclosure.
The authority given to the persons or patties named above shall supersede any agreement that I may have made with my health care providers to restrict access to or disclosure of my individually identifiable health information. The authority given has no expiration date and shall expire only in the event that I revoke the authority in writing and deliver it to my health care provider.
By placing my order with the Collective I confirm that I have read, agreed and understand the information in this Authorization form.
I understand that all plants, seeds, clones, teens, dry flowers or concentrates acquired from our collective have 0% THC and are not “Marijuana” plants but CBD plants. In accordance with the memorandum dated December 20, 2022, issued by the U.S. Department of Justice Drug Enforcement Administration (DEA), any clones, seeds, dry flowers, concentrates, or any form or shape resembling Cannabis Sativa L. shall be deemed to contain 0% THC and are categorized as ‘hemp’ under the Controlled Substances Act (CSA), provided their delta-9-tetrahydrocannabinol (THC) concentration does not exceed 0.3 percent on a dry weight basis, as outlined in 7 U.S.C. § 1639o(1). Therefore, such products are not considered ‘marijuana’ but are recognized as CBD plants for the purpose of promoting wellbeing.
As an express conditions to (a) becoming a member of California Organic Cannabis Clones Collective (“Collective”), (b) entering the Collective’s facility, and/or (c) obtaining medical cannabis, or any other product, herb, food,
oil, or concentrate (collectively, “Cannabis Products”) from the Collective, the undersigned for himself/herself, his/her heirs, agents, representatives, and assigns, hereby irrevocably and forever releases and discharges, waives, relinquishes, quitclaims, settles and forgives all rights, interests, claims, demands, causes of action or chooses in action of whatsoever kind or nature, whether absolute, contingent, known, unknown, suspected or otherwise, and whether now existing or arising in the future, which they may now or hereafter have against the Collective, its members, officers, employees, agents, representatives, assigns, landlords, operators, managers, attorneys, growers, providers, wholesalers, and other members arising from
or in any way related to:
1. The undersigned’s use of any Cannabis Products obtained from the Collective;
2. The strength, potency, purity, toxicity, appropriateness for your condition of any Cannabis Products obtained from the Collective;
3. The undersigned’s storage or handling of Cannabis Products obtained from the Collective.
It is the intention of the undersigned that these Terms and Conditions shall be given full force and effect in
accordance with each and all of the terms and provisions hereof, with respect to all claims, demands and
causes of action which are subject to the provisions of paragraph and subparagraphs above, including,
without limitation, all unknown or unsuspected claims, demands and causes of action, if any, and, in this
regard, and without limiting the generality of any other term or provision hereof, the undersigned on behalf
of his/her heirs, agents, representatives, and assign, does hereby expressly and irrevocably waive the provisions of California Civil Code Section 1542, and all of the rights and benefits conferred thereby, which provides as follows:
“A general release does not extend to claims which the creditor does not know or suspect to exist in his favor at the time of executing the release, which if known must have materially affected his settlement with the debtor.”
AS EXPRESS CONDITIONS TO (A) BECOMING A MEMBER OF THE COLLECTIVE, (B)
ENTERING THE COLLECTIVE’S FACILITY, AND/OR (C) OBTAINING CANNABIS
PRODUCTS FROM THE COLLECTIVE, THE UNDERSIGNED FOR HIMSELF/HERSELF,
HIS/HER HEIRS, AGENTS, REPRESENTATIVES, AND ASSIGNS, HEREBY IRREVOCABLY
AND FOREVER WAIVES AND DISCLAIM THE WARRANTY OF MERCHANTABILITY AND
THE WARRANTY OF FITNESS FOR A PARTICULAR PURPOSE.
KEEP MEDICINE FAR, FAR AWAY FROM CHILDREN OR ANYONE ELSE, UNDER LOCK AND
KEY. ANY DEVIATION FROM THIS RULE IS DONE AT THE SOLE RISK AND RESPONSIBILITY
OF THE PATIENT.
Any Cannabis Products obtained at the Collective’s facility may be inspected prior to leaving the facility, however since medical purity so requires, all transactions are final. The Cannabis Products are offered solely on an AS IS basis with no warranty whatsoever.