ACKNOWLEDGEMENTS: Please read each statement below and sign at the bottom.

I will not engage in the diversion of marijuana. Distribution or selling of Medical Marijuana is a felony.

I understand that my patient registration card only allows me to use and possess marijuana in the state of Massachusetts.

I understand marijuana has not been analyzed or approved by the FDA.

I understand driving is strictly prohibited under the influence of marijuana.

I understand I should not operate any machinery while under the influence.

I understand marijuana use during pregnancy and breast-feeding may pose potential harms.

There is limited information on the side effects and possible health risks to using marijuana.

I understand I may not distribute marijuana to another person and must return any unused products to SIRA for proper disposal.

I understand all marijuana should be kept away from children.

I agree to never bring weapons or anything which could be used as a weapon into the dispensary.

I agree to use medical marijuana in a responsible manner and not harm any other person.

I understand that SIRA can refuse to dispense medical marijuana to me if it is deemed the Public or myself could be at risk in any way by doing so. If this happens, I realize my Certifying Physician will be informed within 24 hours.

I agree to abide by Massachusetts Law regarding my use of medical marijuana and release and waive any, and all claims and liability against SIRA Naturals, Inc.

I give permission to SIRA to share my information between all SIRA dispensaries.

I give permission to SIRA Naturals to contact me by text and email.

By signing below I agree and understand all of the above *
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