Fill and Sign the Donor Form 497330875

Sperm Donor Agreement Agreement made on the ____________________________ (date) , between _____________________________________ (Name of Donor) of ______________________ ____________________________________________________________________________ (street address, city, county, state, zip code) , referred to herein as Donor , and _________________________________ (Name of Recipient) of _______________________ ____________________________________________________________________________ (street address, city, county, state, zip code) , referred to herein as Recipient . 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: 1. Donor has agreed to provide his semen to the Recipient for the purpose of insemination. The parties have further agreed that the Donor ’s semen may be frozen at the time of donation and may be used by the Recipient at a subsequent time. 2. Each party acknowledges and agrees that the Donor is providing his semen for the purpose of insemination, and does so with the clear understanding that he will not demand, request, or compel any guardianship, custody, or visitation rights with any child resulting from the insemination procedure. Further, the Donor acknowledges that he fully understands that he will have no parental rights whatsoever with any such child. To the extent necessary to accomplish the purpose and Agreement regarding this donation, Donor relinquishes any right he now has or may hereafter have in the custody of any such child or children or any visitation rights. 3. Each party acknowledges and agrees that the Recipient , through this Agreement, has relinquished any and all rights that she might otherwise have to hold the Donor legally, financially, or emotionally responsible for any child that results from the insemination. The parties further agree that Recipient may share her sole parenting responsibility with a partner of her choice, if the partner adopts the child. The Donor need not be consulted, and he gives his approval for such an adoption and shared parental responsibilities. Donor will not interfere in any decisions the Recipient makes to have another person adopt and co-parent the child. 4. Each Party acknowledges and agrees that the sole authority to name any child resulting from the insemination shall rest with the Recipient . 5. Each Party acknowledges that the Donor shall not be named as the father on the birth certificate of any child born from the insemination. 6. Each party has executed this Agreement with the purpose of clarifying his/her intent to release and relinquish any and all rights he/she or may have to bring a suit to establish the paternity of any child conceived through insemination. 7. Each Party covenants and agrees that, in light of the expectations of each Party, as stated above, Recipient shall have absolute authority and power to appoint a guardian for her child, and that the Recipient and such guardian may act with sole discretion as to all legal, financial, medical, and emotional needs of said child without any involvement with or demands of authority from Donor . 8. (Optional) Each party covenants and agrees that none of them will identify the Donor as the parent of the child, nor will either of them reveal the identity of the Donor to any of their respective relatives or to any individual without the express written consent of the other party. (Optional) Each party agrees that the Donor will not be referred to by himself or by the Recipient as Father or Dad to friends and family, as he has relinquished paternity rights. 9. Each party acknowledges and agrees that the relinquishment of all rights, as stated above, is final and irrevocable. The Donor further understands that his waivers shall prohibit action on his part for custody, guardianship, or visitation in any future situation, including the event of the Recipient ’s disability or death. 10. Each party acknowledges and agrees that any future contact the Donor may have with any child that result form the insemination in no way alters the effect of this agreement. Any such contact will be at the sole discretion of the Recipient and will be consistent with the intent of both parties to sever all parental rights and responsibilities of the Donor . All parties do also acknowledge that in the best interest of the child, if the child at any time requests to meet or form a friendship with the Donor , it is the intention of the Donor to be receptive to such contact. All agree that any friendship formed between the Donor and the child does not construe a parental relationship with any of its concomitant rights or responsibilities. 11. (Optional) the Donor agrees to keep the Recipient updated with current address and contact information so that the child can make contact in the future. 12. 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. 13. Each party acknowledges and understands that there may be legal questions raised by The issues involved in this Agreement, which have not been settled by statute or prior court decision. Notwithstanding the knowledge that certain clauses stated herein may not Be enforced by a court of law, the parties choose to enter into this Agreement as binding. 14. Each party acknowledges and agrees that she or he signed this Agreement voluntarily and freely, of his or her own choice, without any duress of any kind whatsoever. It is further acknowledged that each party has been advised to secure the advice and consent of an attorney of his or her own choosing, and that each party understands the meaning and significance of each provision of the Agreement. 15. This Agreement shall constitute the entire agreement between the parties and any prior understanding or representation of any kind preceding the date of this Agreement shall not be binding upon either party except to the extent incorporated in this Agreement. WITNESS our signatures as of the day and date first above stated. ____________________________ __________________________ (Name of Donor) (Recipient) STATE OF __________________ COUNTY OF __________________ Personally appeared before me, the undersigned authority in and for the said county and state, on this _____ day of _______________, 20____, within my jurisdiction, the within named, ______________________________ (Name of Donor) , who acknowledged that he executed the above and fore going instrument. _____________________________ NOTARY PUBLIC My Commission expires: ______________________ STATE OF ___________________ COUNTY OF ____________________ Personally appeared before me, the undersigned authority in and for the said county and state, on this ______ day of ________________, 20_____, within my jurisdiction, the within named, ___________________________ (Name of Client) , who acknowledged that she executed the above and fore going instrument. _____________________________ NOTARY PUBLIC My Commission expires: ______________________