Fill and Sign the Surrogacy Agreement Form

Surrogacy Agreement for Artificial Insemination between Husband, Wife, and Donor -- Identity of Donor Known This Agreement is made on this the ____________________ (date), between ________________________ (Name of Prospective Mother) , of _______________________ _____________________________________ (street address, city, county, state, zip code) , hereinafter called the Recipient, _______________________ (Name of Recipient's Husband) , of __________________________________________________________________________ (street address, city, county, state, zip code) , hereinafter called Husband, and ________________________ (Name of Sperm Donor), of ____________________________ _____________________________________ (street address, city, county, state, zip code) , hereinafter called the Donor. Whereas, Recipient and her Husband desire to have a child through artificial insemination using sperm donated by Donor, and Husband consents to use of semen donated by Donor for purposes of artificial insemination; and Whereas, Donor desires to donate sperm to Recipient and Husband to enable them to have a child through artificial insemination; and 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: 1. Medical Examination and Testing Prior to donating sperm to Recipient and Husband , Donor agrees to undergo a complete physical and genetic examination to be performed by _____________________ (Name of Physician) . 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 and Husband prior to insemination. Donor also agrees to give true and complete answers to all questions asked by the examining physician regarding Donor's health and background. In the event that 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 notice of such cancellation to Donor. 2. Sperm Donation Donor agrees to provide semen to ________________________ (Name of Sperm Bank or Physician) for artificial insemination of Recipient on the following schedule: (describe donation schedule) ___________________________ for a period of (describe duration of donation) _________________________. If, after the expiration of that time period, Recipient has not conceived a child, Recipient may cancel this Agreement by giving notice of such cancellation to Donor. 3. Paternity of Child Donor waives any paternity rights to a child or children conceived through artificial insemination of sperm donated pursuant to this Agreement. Donor understands that Recipient shall place her Husband's name on the birth certificate as the child's father. Donor further agrees not to attempt to form a parent-child relationship with Recipient's child. 4. Confidentiality Donor agrees to refrain from discussing Donor's participation in donating sperm under this Agreement with persons other than the parties or their physicians. 5. Donor’s Fee Recipient and Husband agree to pay for Donor's physical and genetic examination. In addition, Donor shall receive a flat fee of $____________ in compensation for Donor's sperm, and for Donor's time, inconvenience, loss of income, and travel expenses. 6. Severability The invalidity of any portion of this Agreement will not and shall not be deemed to affect the validity of any other provision. If any provision of this Agreement is held to be invalid, the parties agree that the remaining provisions shall be deemed to be in full force and effect as if they had been executed by both parties subsequent to the expungement of the invalid provision. 7. No Waiver The failure of either party to this Agreement to insist upon the performance of any of the terms and conditions of this Agreement, or the waiver of any breach of any of the terms and conditions of this Agreement, shall not be construed as subsequently waiving any such terms and conditions, but the same shall continue and remain in full force and effect as if no such forbearance or waiver had occurred. 8. Governing Law This Agreement shall be governed by, construed, and enforced in accordance with the laws of the State of ______________. 9. Notices Any notice provided for or concerning this Agreement shall be in writing and shall be deemed sufficiently given when sent by certified or registered mail if sent to the respective address of each party as set forth at the beginning of this Agreement. 10. Attorney’s Fees In the event that any lawsuit is filed in relation to this Agreement, the unsuccessful party in the action shall pay to the successful party, in addition to all the sums that either party may be called on to pay, a reasonable sum for the successful party's attorney fees. 11. Mandatory Arbitration 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. 12. Entire Agreement 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. 13. Modification of Agreement Any modification of this Agreement or additional obligation assumed by either party in connection with this Agreement shall be binding only if placed in writing and signed by each party or an authorized representative of each party. 14. Assignment of Rights The rights of each party under this Agreement are personal to that party and may not be assigned or transferred to any other person, firm, corporation, or other entity without the prior, express, and written consent of the other party. 15. In this contract, any reference to a party includes that party's heirs, executors, administrators, successors and assigns, singular includes plural and masculine includes feminine. WITNESS our signatures as of the day and date first above stated. ________________________ _________________________ (Printed name) (Printed name) ________________________ _________________________ (Signature of Husband) (Signature of Wife/Recipient) ________________________ (Printed name) (Signature of Donor)