Fill and Sign the Natural Mother Form

Adoption Agreement Between Married Prospective Adoptive Parents and Pregnant Natural Mother with Prospective Adoptive Parents Agreeing to Pay Medical and Hospital Costs of Pregnant Natural Mother Agreement made on ________ (date) , between ___________________________ and his wife ________________________________ herein referred to as Adopting Parents, and ____________________________________ herein referred to as Natural Mother. Whereas, Adopting Parents desire to adopt, pursuant to law, the child of Natural Mother on the child's birth and will initiate adoption proceedings, through legal counsel, to legalize the adoption. Whereas, Natural Mother feels that it is in the best interests of her yet-to-be-born child that the child be adopted by Adopting Parents and brought up by them in their household as their child. 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: A. Adopting Parents agree to pay into a trust fund established by their attorney ______________________________________ (name of attorney), whose offices are located at _____________________________________________________________________________ _________________________ (street address, city, county, state, zip code) , sums in a sufficient amount to pay the following expenses of Natural Mother out of the trust fund: 1. All medical expenses incurred in connection with the birth of Natural Mother's child. 2. All hospital expenses incurred in connection with the birth of the child. 3. All costs incurred in connection with the issuance and registration of all documents required in the adoption proceedings. B. Natural Mother states that she is pregnant as of the date of this Agreement and has been informed by her physician that she is carrying one child in her womb. Natural Mother agrees to carry the child to term and give birth to the child. C. Natural Mother agrees that she will not form or attempt to form a parent-child relationship with the child to which she gives birth, and will execute any and all documents necessary on or shortly after the birth of the child to relinquish the child to Adopting Parents , and will cooperate fully with Adopting Parents in the adoption proceedings. D. Notwithstanding the foregoing, and anything herein to the contrary, 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. ____________________________________ (Natural Parent) _____________________________________ (Adoptive Parent) _____________________________________ (Adoptive Parent) Acknowledgments (form may vary by state)