Fill and Sign the Agreement Insemination Form

Agreement for Artificial Insemination Between Recipient and Donor Agreement made on the ___ day of __________, 20___, between _____________ of _________________________________ (street address, city, county, state, zip code), referred to herein as Donor, and _________ of __________________________________ (street address, city, county, state, zip code), referred to herein as Recipient , Whereas, Recipient desires to have a child through artificial insemination using sperm donated by Donor. Whereas, Donor desires to donate sperm to Recipient to enable her to have a child through artificial insemination. Whereas, Recipient understands that pregnancy involves risks such as miscarriage, difficult delivery, and birth defects in the child, and that such risks attach to conception through artificial insemination as well. Now, therefore, for and in consideration of the mutual covenants contained in this agreement, and other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the parties agree as follows: I. Medical Examination and Testing Prior to donating sperm to Recipient, Donor agrees to undergo a complete physical and genetic examination to be performed by __________________ (e.g., name of physician or clinic) . In addition, Donor agrees to be tested for venereal disease and Human Immunodeficiency Virus (HIV). A copy of the results of Donor's examination and testing shall be provided to Recipient prior to insemination. Donor also agrees to give true and complete answers to all questions asked by the examining physician regarding his health and background. If such medical examination and testing reveals that Donor has a venereal disease, is HIV positive, or may transmit a genetic defect, Recipient may cancel this agreement by giving ____ days notice of such cancellation to Donor. I. Sperm Donation Donor agrees to provide semen to _______________________ (e.g., sperm bank, physician or clinic) for artificial insemination of Recipient for a period of ___________ ( e.g., duration of donation ) . If, after the expiration of that time period, Recipient has not conceived a child, she may cancel this agreement by giving notice of cancellation to Donor. II. Paternity of Child Donor waives any paternity rights to a child conceived through artificial insemination of sperm donated pursuant to this agreement. Donor further agrees not to attempt to form a parent-child relationship with Recipient's child. III. Confidentiality Donor agrees to refrain from discussing his participation in donating sperm under this agreement with persons other than Recipient or the physicians involved. IV. Donor’s Fee and Expenses (Optional) Recipient agrees to pay for Donor's physical and genetic examination. In addition, Donor shall receive a flat fee of $________ in compensation for the donation of sperm , and for Donor's time, inconvenience, loss of income, and travel expenses. V. Governing Law This agreement shall be construed under and in accordance with the laws of the State of ____________. If any portion of this agreement is held invalid or unenforceable, the remaining portion of this agreement shall continue in effect. VI. Enforcement If any legal action is brought to enforce the terms of this agreement, the prevailing party shall be entitled to reasonable attorney's fees paid by the other party in addition to any other relief that may be granted. Notwithstanding the foregoing, and anything herein to the contrary notwithstanding, any dispute under this agreement shall be required to be resolved by binding arbitration of the parties hereto. If the parties cannot agree on an arbitrator, each party shall select one arbitrator and both arbitrators shall then select a third. The third arbitrator so selected shall arbitrate said dispute. The arbitration shall be governed by the rules of the American Arbitration Association then in force and effect. WITNESS our signatures as of the day and date first above stated. _____________________ _______________________ DONOR RECIPIENT