As an applicant or a Responsible Individual you acknowledge, attest, agree and consent to the following:
- (i) the applicant ordinarily resides in Canada;
- (ii) the information in the application is correct and complete;
- (iii) the medical document that forms the basis for the application has not, to the knowledge of the individual signing the statement, been altered;
- (iv) the medical document is not being used to seek or obtain cannabis products from another source;
- (v) in the case where the applicant is signing the statement, they intend to use any cannabis product that is supplied to them on the basis of the application only for their own medical purposes;
- (vi) in the case where an adult who is responsible for the applicant is signing the statement, they are responsible for the applicant; and
- (vii) I authorize Starseed, its agents, affiliates including Entourage Brands Corp., service providers and my health care practitioner to disclose my personal health information consisting of: dose information of cannabis used for medical purposes, as a verification of the healthcare practitioner's orders, as required and on a continuous basis. I have been informed of how my personal health information will be used and understand the purpose for disclosing my personal health information noted above. I understand that I can refuse to sign this consent, and this may be withdrawn or amended at any time.
- (viii) I authorize Starseed, its agents, affiliates including Entourage Brands Corp., service providers and my health care practitioner to disclose and share my medical documentation to my referring clinic for patient monitoring and audit purposes, as well as compliance with the law, as required and on a continuous basis. I have been informed of how my medical documentation will be used and understand the purpose for disclosing my medical documentation noted above. I understand that I can refuse to sign this consent, and this may be withdrawn or amended at any time.
You acknowledge that cannabis products are not an approved therapeutic products and cannabis has not been authorized through the standard Health Canada drug approval process because the available scientific evidence does not establish the safety and efficacy of cannabis to the extent required by the Food and Drug Regulations for marketed drugs in Canada.
You acknowledge that you are using any medical cannabis or related product obtained from Entourage Brands Corp. at your own risk. You also specifically release Entourage Brands Corp. (and its service providers, officers, directors and staff) from any and all actions, claims, complaints and demands for damages, loss or injury whatsoever, whether arising directly or indirectly as a consequence of your use of Starseed's products or services.
You consent to the health care practitioner named in this registration application disclosing to Entourage Brands Corp. your personal health information by phone, physical means or digital means (including Starseed's online portal or SFax secure system) for the purposes of processing this registration (which may include the submission of Medical Document by digital means), client service and complying with the requirements of the Cannabis Regulations, and any other applicable laws. You understand and agree that a copy of this consent and registration application may be provided to the healthcare practitioner named in this registration.