MN Med Cannabis COVID-19 Response Volunteer Sign-Up
With COVID-19 in the community, we would like to work on helping patients get their medical cannabis. Governor Walz issued Executive Order 20-26 on March 31, 2020, which allows for the registration of temporary, emergency caregivers, who can serve more than one patient.

We are asking for volunteers who are willing to serve as temporary, emergency, caregivers, and offering services to patients who need their medical cannabis delivered.

*HOW DOES IT WORK?*
Sensible Minnesota will match a patient with a volunteer caregiver based upon where they live and where the caregiver is willing and able to travel. The patient and volunteer will then register the volunteer as an emergency, temporary caregiver with the Minnesota Department of Health. This does require the caregiver to upload a copy of their state-issued identification card, but the current BCA background check requirement through MDH is suspended.

Patients and volunteers should work between themselves to determine the best way to facilitate the transfer of money and medical cannabis; please remember it is illegal to use banking for medical cannabis. Minnesota Medical Solutions does have Canpay as an online payment option, and can help you register and navigate the app, but it will still require coordination with the volunteer caregiver. You can also use Venmo to transfer money, and the volunteer can request a Venmo debit card to use to purchase the medical cannabis at the patient care center.

*WHO ARE THE VOLUNTEERS?*
Sensible Minnesota has opened up volunteer opportunities to those that are able and willing to deliver medical cannabis to patients. However, given the requirement for a background check by MDH has been suspended, Sensible Minnesota *will* be conducting background checks.

*IMPORTANT* VOLUNTEERS: If you are exhibiting symptoms of COVID-19 or are confirmed to have COVID-19 *do not* sign-up as a volunteer. When possible, please use no-contact delivery.

At this time, we do not have funds available for reimbursement for volunteers and volunteers should not ask for money from the patient, except for reimbursement for the medical cannabis if they purchase in advance.

DISCLAIMER: Sensible Minnesota is only connecting patients with community members able to provide caregiver and delivery services for patients. No volunteer should be considered an agent or employee of Sensible Minnesota. Our role is simply to connect people who need help, with people who can help, to take care of our neighbors and friends during this time. By submitting this form, I agree to defend, indemnify and hold Sensible Minnesota harmless from any and all claims, loss or damage to my personal property, liabilities and costs, including attorney’s fees, as a result of my participation in this program.  Participation in this program constitutes a privilege and constitutes sufficient consideration to render this clause enforceable against me and in favor of Sensible Minnesota.
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Full Name *
Address *
City, State, Zip *
Phone Number *
Can we text you? *
Date of Birth *
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DD
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Email Address *
Volunteers: Have you ever been convicted of a crime of dishonesty, theft, or controlled substance crime?
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Volunteers: How long have you lived in the State of Minnesota?
Who is at higher risk for serious complications of COVID-19?
According to the Minnesota Department of Health, underlying medical conditions that may increase the risk of serious COVID-19 for individuals of any age:

   * Blood disorders (e.g., sickle cell disease or on blood thinners).
   * Chronic kidney disease as defined by your doctor. Patient has been told to avoid or reduce the dose of medications because kidney disease, or is under treatment for kidney disease, including receiving dialysis.
   * Chronic liver disease as defined by your doctor. (e.g., cirrhosis, chronic hepatitis) Patient has been told to avoid or reduce the dose of medications because liver disease or is under treatment for liver disease.
   * Compromised immune system (immunosuppression) (e.g., seeing a doctor for cancer and treatment such as chemotherapy or radiation, received an organ or bone marrow transplant, taking high doses of corticosteroids or other immunosuppressant medications, HIV or AIDS).
   * Current or recent pregnancy in the last two weeks.
   * Endocrine disorders (e.g., diabetes mellitus).
   * Metabolic disorders (such as inherited metabolic disorders and mitochondrial disorders).
   * Heart disease (such as congenital heart disease, congestive heart failure and coronary artery disease).
   * Lung disease including asthma or chronic obstructive pulmonary disease (chronic bronchitis or emphysema) or other chronic conditions associated with impaired lung function or that require home oxygen.
   * Neurological and neurologic and neurodevelopment conditions [including disorders of the brain, spinal cord, peripheral nerve, and muscle such as cerebral palsy, epilepsy (seizure disorders), stroke, intellectual disability, moderate to severe developmental delay, muscular dystrophy, or spinal cord injury.
Are you high risk for COVID-19? *
*Please Note* - High Risk Patients
High risk patients should work with their caregiver on no-contact delivery whenever possible. If patients and caregivers need to meet, high-risk patients should wear a N95 mask, disinfect all products from the dispensaries before putting away, and wash their hands when done.

Drivers: please contact info@sensible.mn *immediately* if you have been exposed to COVID-19 or are exhibiting symptoms, including cough, fever, or chest pain, so we can deactivate you as a volunteer.
How far are you willing to travel? #of miles round trip
*Volunteers* Which care centers can you drive to?
Do you have car insurance?
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Do you hold a valid driver's license?
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Acknowledgement
By electronically signing my name below, I declare under penalty of perjury that the information I have provided is true and accurate to the best of my knowledge. I agree to defend, indemnify and hold Sensible Minnesota harmless from any and all claims, loss or damage to my personal property, liabilities and costs, including attorney’s fees, as a result of my participation in this program.  Participation in this program constitutes a privilege and constitutes sufficient consideration to render this clause enforceable against me and in favor of Sensible Minnesota.

*Volunteers only* I understand that Sensible Minnesota will use the Minnesota Bureau of Criminal History Public Search to look for disqualifying offense in the past 15 years.
Electronic Signature (type your name) *
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