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SHSG Herbal Apothecary Pick-Up Form & Liability Waiver
First name
*
Last name
*
Email
*
Phone
*
Address
*
Medicine(s) Picking Up
*
Desired Pick-Up Date/Time
I have reviewed the Disclaimers tab on the SHSG Apothecary page and understand and agree to what is written therein. I release SHSG and all its volunteers from any liability related to herbs I choose to obtain from the SHSG Free Community Apothecary
*
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