CANNAGIRL SMOKE — MEMBERSHIP AGREEMENT, LIABILITY WAIVER, SECTION 21 PATIENT INTAKE & INFORMED CONSENT FORM
(In terms of SAHPRA, Medicines and Related Substances Act, Section 21)
This document serves as:
• CannaGirl Smoke Membership Agreement
• Liability Waiver
• Privacy Policy acknowledgment
• Section 21 Patient Intake Form (SAHPRA compliant)
• Informed Consent Form for use of unregistered medication (< 1% Delta-9-Tetrahydrocannabinol)
By accepting membership with CannaGirl Smoke, you confirm that you have read, understood, and agree to all the terms in this document, and you provide the necessary patient information and consent required by SAHPRA.
1. SECTION 21 OVERVIEW
1.1 What is Section 21?
Before any medicine can be sold in South Africa, it must be approved by the South African Health Products Regulatory Authority (SAHPRA), which certifies that the medicine is safe, of good quality, and effective. Unless a medicine has completed this approval process, it cannot legally be sold in South Africa.
In exceptional circumstances, SAHPRA may permit access to unregistered medicines. This is allowed under Section 21 of the Medicines and Related Substances Act, 101 of 1965, a process commonly referred to as a Section 21 application.
1.2 Dispensing of Medicinal Cannabis
Under the Medicines Act, medical practitioners can apply to SAHPRA for permission to access and prescribe unregistered medicines, including cannabis, for their patients in specific exceptional circumstances.
The only legal way for a patient to obtain medicinal cannabis in South Africa is through a medical practitioner who holds a valid Section 21 authorisation from SAHPRA.
A registered pharmacist may dispense medicinal cannabis when presented with a legitimate prescription from such a medical practitioner.
Medicinal cannabis products may only be made available to specific patients, under medical supervision, and through legal channels as outlined by SAHPRA.
2. WHO WE ARE
CannaGirl Smoke is a Section 21-approved facility under the Medicines and Related Substances Act, authorised to dispense medicinal cannabis products to registered members on prescription from a licensed medical practitioner.
We do not permit the smoking or consumption of cannabis on our premises.
Cannabis products are dispensed for personal, off-site use only in compliance with your prescription.
We do not provide medical, legal, or financial advice beyond educational information about cannabis.
CG Coffee is a separate, public coffee shop and is not part of the membership programme or cannabis dispensing process.
3. MEMBERSHIP TERMS
• Membership is R60 per month, payable in advance.
• Membership fees may be adjusted from time to time at CannaGirl Smoke’s discretion.
• Only verified members aged 18 and above may join and access membership benefits.
• Membership requires valid ID or passport and completion of this Section 21 Patient Intake & Consent Form.
• Membership remains active only while payments are up to date.
4. PATIENT INFORMATION (Required by SAHPRA)
• Full Name
• Date of Birth
• ID/Passport Number
• Residential Address
• Phone Number
• Email Address
5. MEDICAL DETAILS (Required by SAHPRA)
• Treating Medical Practitioner
• Practice Number
• Diagnosis / Condition being treated
• Prescribed Cannabis Product(s)
• Dosage & Instructions
6. RISKS & RESPONSIBILITIES
Cannabis can be potent. Use only as prescribed.
Do not share your medication with others.
Avoid mixing with alcohol or other drugs unless advised by your doctor.
Keep products away from children and pets.
Consult your doctor if you experience side effects.
7. LEGAL COMPLIANCE
All cannabis dispensing is carried out in line with SAHPRA Section 21 approval.
Any illegal resale, diversion, or misuse of your prescription will result in cancellation of membership and may lead to legal action.
8. PRIVACY & DATA PROTECTION
In compliance with POPIA, we collect and store only necessary personal and medical information to fulfil our Section 21 and membership obligations.
We do not sell your data.
Your information may be shared with:
• SAHPRA (for compliance and reporting)
• Your prescribing medical practitioner
• Legal authorities if required by law
9. WAIVER OF CLAIMS
By accepting membership, you waive all legal claims against CannaGirl Group (Pty) Ltd, its owners, employees, and partners for:
• Any health complications from cannabis use
• Legal consequences from non-compliance with your prescription or the law
• Loss, theft, or damage to personal property while on our premises
10. INFORMED CONSENT FORM (Required by SAHPRA)
By accepting membership, you also give informed consent that:
You voluntarily agree to be treated with a medication, namely < 1% Delta-9-Tetrahydrocannabinol, which is not registered in South Africa.
You have been fully informed, and your questions have been answered, about:
• Your condition (for which a Section 21 application is being made)
• Its cause, severity, and prognosis
• The available registered treatment options in South Africa
• The reasons for your current state of illness
• The unregistered medication being prescribed and the application to use it
You understand and agree that:
• This medication is not registered in South Africa, and its quality, effectiveness, and safety have not been verified by SAHPRA.
• The medication will only be supplied to you once specific approval has been obtained from SAHPRA.
• Appropriate measures will be taken to prevent, monitor, and manage any unwanted effects.
• Use of the medication is for managing your disease and not for medical research.
• You are free to stop using the medication at any time and will inform your treating doctor if you do so.
11. ACCEPTANCE
By becoming a member of CannaGirl Smoke, you:
• Confirm that you have read, understood, and agree to all terms in this document.
• Acknowledge that this serves as your Section 21 Patient Intake Form and Informed Consent Form for SAHPRA purposes.
• Consent to the collection and use of your personal and medical information for Section 21 compliance.
• Agree to pay your monthly membership fee of R60, understanding it may change from time to time.