I ______________________________ have read Ageia Health Service’s, dba, (resident/client printed name) _________________________________ (community name), policy regarding medical marijuana. I understand and agree to follow the conditions and requirements set forth for those patrons that will be grandfathered under this policy. These conditions are: 1) Use of product will not infringe on others, including staff members and other residents. Second hand smoke inhalation and residual smell will render the accommodation as unreasonable; therefore, the product must be in smokeless form. 2) Resident/client must meet federal and state Clean Air Act requirements, as well as, Ageia’s policies regarding maintenance of property, both resident apartment and common grounds. 3) The product must be secured in a locked device during the time that staff is providing services. 4) Resident/client must arrange the acquisition and administration of the product without the assistance of Ageia staff. I also understand that the company retains the right to update or change this policy, as needed, with proper client notification. If there is a breach in this agreement, At Home Care Group reserves the right to give notice regarding discontinuation of service. ________________________________________ (Resident/Client Signature)
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________________________________________ (Community Representative Signature)
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