Clones Registration Form

Step one:
To register as a customer for the purchase of medicinal cannabis plants or seeds, you must complete and sign this Registration Form.

Please do not hesitate to give us a call 902-262-2024 if you have any questions or concerns about any of these forms, we will be happy to walk through each step of the application with you.

Step two:
You will need to send a copy of your Personal Use Production License that you received from Health Canada. 

Please email all supporting documents to: mparker@westrivercannabis.ca

Thanks again for choosing us for your medical cannabis needs.

 

    Applicant's Information

    The “Applicant” is the person who the medical cannabis is for. If you are applying for yourself, then that is you. If you are a substitute decision maker, it is the person you are applying for.

    Are you applying directly for medical cannabis or are you a caregiver applying on behalf of somebody else?

    Preferred Language?

    Note: Many licenses to grow do not need renewals. Fill in the expiration date listed on your Personal Use Production License.

    Applicant's Address

    Is this also your mailing address?

    Substitute's Information

    Health Care Practitioner Information

    Are applying on the basis of registration certificate issued by the minister?

    Is the application is being made for the purpose of obtaining an interim supply of cannabis seeds or plants?

    Please indicate if you would like the cannabis plants shipped to:

    Shipping

    Where will we be shipping your medical cannabis?

    I have the consent of the Designated Grower to receive cannabis products on behalf of the applicant.

    Can We Stay Friends?

    Please indicate if we may also contact you:

    Disclaimer

    By signing this Registration Form, you give us permission to send medical cannabis and your registration information to the shipping address provided.
    You also give us permission to communicate with you at your listed email address so that we can provide you with information related to your account purchases.
    If you do not provide an email address, we will be happy to assist you with placing an order over the phone.

    • You also acknowledge that you are a resident of Canada.

    • The information provided in this application is accurate and complete.

    • The valid Personal Use Production License accompanies this application.

    • The Applicant will use cannabis products for their own medical purposes only.