Note: Personally, I would copy the driver license onto this form (Certified Medical User) after the form has been filled out.

Primary Caregiver Agreement

It is hereby agreed between __Jan Smith (needy medical patient)____, a certified medical user of cannabis, and __John Doe (grower)________an individual who is willing to assist the above medical user in growing and/or obtaining medical cannabis, that the relationship of the certified user and the primary caregiver is herby established by this agreement. The certified user agrees to keep their medical certification current and to advise the caregiver if such status changes. Further, said certified user will appear and testify to the fact and intent established by this agreement should that testimony become necessary to defend said caregiver against cannabis charges.

                               ____________________Jan Smith (needy medical Patient) _____________

                                                      CERTIFIED Medical User

  
                               ____________________John Doe (grower) ______________________

                                                                   Caregiver

 State of California

 County of ( ________________________________)

On ____/______/________ before me, the undersigned personally appeared _______Bob Davis  (witness)_______ whose names are subscribed to the within instrument an acknowledgment to me that her/his authorized capacity, and her/his signature on this instrument that the person or entity upon behalf of which the person acted, executed be instrument.

 Witness by my hand and official seal.  ___Bob Davis (witness)____________________