Capony Canada Holdings Inc. (“Capony”) is required to collect the information of the Applicant pursuant to the Cannabis Act as may be amended from time to time. Capony collects, uses, and discloses personal information only in accordance with the provisions of the Personal Information Protection and Electronic Documents Act, the applicable provincial Personal Information Protection Act, the Cannabis Act, and Capony’s Privacy Policy. At Capony, we take your privacy seriously. Any information collected by opting in to receive correspondence from Capony is retained and disclosed in strict accordance with our privacy policy, which can be viewed in full on our website.

By submitting this application, the Applicant acknowledges and agrees to the following:

• Assumption of Risk: Medical cannabis is not approved for use as a drug in Canada, and its risks and appropriate dosages have not been determined. The Applicant acknowledges that they are using medical cannabis at their own risk and that Capony is not liable for any damages, loss, or injury whatsoever that results, either directly or indirectly, from the use of medical cannabis.
• Information Sharing: Some of the information provided in this document may be shared with our service providers for shipping purposes only. Where the Applicant has been referred to Capony by a third-party intermediary (i.e., your physician/clinic), Capony may share some personal information collected by Capony, including information provided in this document, with the applicable third-party intermediary. When applicable, Capony may also speak with, and share information with, the Applicant’s health insurer, union, or private benefit provider to maximize the available benefit(s) to the Applicant.
• Eligibility & Usage: The Applicant ordinarily resides in Canada and will use medical cannabis only for their own medical purposes.
• Accuracy of Information: The information in this application and the Medical Document or Registration Certificate is correct and complete. The original Medical Document or Registration Certificate (for interim supply or starting materials) submitted to Capony by yourself or your physician is not being used to seek or obtain medical cannabis from another source.
• Consent to Processing: Capony may collect, use, disclose, and store personal information and personal health information provided by the Applicant, their caregiver, or their health care professional(s) (collectively, the Applicant’s “information”) to determine eligibility for, and registration as, a client of Capony. This includes filling orders, providing information about Capony and its products/services, and obtaining and processing payments by, or on behalf of, the Applicant as applicable.
• Site Transfers: An address change may require us to transfer your registration between our licensed sites. This will not affect you other than your product being fulfilled from a different site. By submitting this form, you consent to such a transfer if required.