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I understand that: I am a legal medical marijuana patient who is entitled to the protections provided by the California Health and Safety Code sections 11362.5 and 11262.7 as well as by Senate Bill 420 and Prop 215 and have the right to obtain and use marijuana for medicinal purposes whereby medical use has been deemed appropriate and has been recommended and/or approved by a physician licensed by the California Medical Board or the California Osteopathic Board, who has determined that my health (i.e., medical problem) would benefit from the use of medical marijuana in the treatment of my medical problems, which I represented in the medical record prior to being evaluated by my doctor whose name and info is affixed on the recommendation I am providing as proof and for my file;

I understand that: The True and Correct copy of my most current physician’s recommendations and or approval of the use of medical marijuana is attached to this agreement;

I understand that I hereby declare under penalty of perjury laws of the State of California that I am at least 18 years old and am a legal medical marijuana patient who was evaluated by a California licensed medical doctor who recommended and approved my use of medical marijuana in accordance with California State Laws and that I have been diagnosed for a serious illness(s) for which cannabis provides substantial relief;

I understand that If my recommendation is revoked or expired and or my doctors State of California medical license is suspended, revoked or expired, that I am no longer a legal medical marijuana patient at Shangri-La Care and will have to provide a replacement medical marijuana recommendation issued by a California license physician whose license is also RENEWED and CURRENT;

I understand that I hereby verify that I am a California resident and my personal medical marijuana will not be taken out of the State of California and I further verify and agree that the medical marijuana that I obtain will NOT be shared, sold, bartered, traded, exchanged and or delivered/used for any other purposes other than personal use;

I understand that I agree to provide Shangri-La Care, with accurate and current personal contact info and further agree to immediately provide and update and changes made to my medical condition(s), address, contact phone number, name, recommendation status, physician contact info and license status, etc., upon any changes that occur from those representations of contact information made in this agreement;

I understand that any member of law enforcement who is a bona fide patient must disclose the fact that he/she is a member of law enforcement. Otherwise, by signing these terms and conditions, I promise, state, and affirm, under penalty of perjury under the laws of the State of California, that I am not a member of, affiliated with, nor employed by any law enforcement department, entity, or agency.