This is an Example Surrogacy Contract Agreement that I had drawn up for what my needs were with my first match. I thought it might be useful for others to see what is included in a surrogacy agreement.
Before you read it I want to make it VERY CLEAR.. surrogacy is NOT about money.. it is about providing an amazing gift for the IP's!!
However having the contract is nice to have to make it clear ALL ASPECTS of the pregnancy to both parties to limit miscommunication or confusion.
Surrogacy Contract Agreement
Between and _________
THIS AGREEMENT is made
this _ day of ______ 2013, by and between (fathers name) and (mother’s
name) (hereinafter referred to as
"Genetic Father and Genetic Mother" or collectively as "Genetic
Parents") and ________________
(hereinafter referred to as "Embryo Carrier").
The Parties are aware that surrogate parenting remains a new and unsettled area of law and that this Agreement may be held unenforceable in whole or in part as against public policy. The parents intend to move to California due to a job offer to the Genetic Father. The mother has shown proof that she cannot carry an embryo to a viable pregnancy. The Embryo Carrier intends to travel to California for Embryo transfer and Delivery. Therefore the Intended parents and Embryo carrier agree to use California State Surrogacy law.
I. Purpose and Intent
The sole purpose and intent of this Agreement is to provide a means for (fathers name) Genetic Father, to fertilize in vitro an ovum from his wife (mother’s name) , Genetic Mother, for transfer and implantation into (surrogate name) , Embryo Carrier, who agrees to carry the ovum/embryo to term and relinquish custody of the child born pursuant to this Agreement to its Genetic Parents, (fathers name) and (mother’s name) .
II. Representations
(fathers name) and (mother’s name) represent that they are a married couple, each over the age of eighteen years, who desire to enter into this Agreement(fathers name) and (mother’s name) further represent that to the best of their knowledge they are respectively capable of producing semen and an ovum(s) of sufficient nature for in vitro fertilization and subsequent transfer into (surrogate name) , Embryo Carrier.
The Parties are aware that surrogate parenting remains a new and unsettled area of law and that this Agreement may be held unenforceable in whole or in part as against public policy. The parents intend to move to California due to a job offer to the Genetic Father. The mother has shown proof that she cannot carry an embryo to a viable pregnancy. The Embryo Carrier intends to travel to California for Embryo transfer and Delivery. Therefore the Intended parents and Embryo carrier agree to use California State Surrogacy law.
I. Purpose and Intent
The sole purpose and intent of this Agreement is to provide a means for (fathers name) Genetic Father, to fertilize in vitro an ovum from his wife (mother’s name) , Genetic Mother, for transfer and implantation into (surrogate name) , Embryo Carrier, who agrees to carry the ovum/embryo to term and relinquish custody of the child born pursuant to this Agreement to its Genetic Parents, (fathers name) and (mother’s name) .
II. Representations
(fathers name) and (mother’s name) represent that they are a married couple, each over the age of eighteen years, who desire to enter into this Agreement(fathers name) and (mother’s name) further represent that to the best of their knowledge they are respectively capable of producing semen and an ovum(s) of sufficient nature for in vitro fertilization and subsequent transfer into (surrogate name) , Embryo Carrier.
(mother’s name) cannot
carry her own embryo as proved by miscarriages and inability to get pregnant
over the past __ years. (put any other reasoning for having a
Surrogate to prove to the courts why it is necessary).
(mother’s name) will go through the process of retrieving
eggs but if they are not viable then the couple will use donated eggs.
The Genetic Parent’s address is: _________________________________________
Phone number(s) to reach Genetic Parents: ______________________________
(surrogate name) represents that she is a divorced woman, over the age of eighteen years, and that she desires to enter into this Agreement for the reasons stated above and not for herself to become the parent of any child conceived (fathers name) and (mother’s name) pursuant to this Agreement. (surrogate name) further represents that to the best of her knowledge she is capable of carrying an implanted ovum/embryo to term.
(surrogate name) represents that she is a divorced woman, over the age of eighteen years, and that she desires to enter into this Agreement for the reasons stated above and not for herself to become the parent of any child conceived (fathers name) and (mother’s name) pursuant to this Agreement. (surrogate name) further represents that to the best of her knowledge she is capable of carrying an implanted ovum/embryo to term.
The Embryo Carrier’s address is :
Phone
number(s) to reach Embryo Carrier: Cell phone
III Selection of Physicians and Counselor.
A. Genetic Parents and Embryo Carrier will jointly select physician(s) to examine Embryo Carrier, order and review medical and blood tests for Genetic Parents, Embryo Carrier, and perform IVF procedures (the "Responsible Physician"). The parties will select a doctor to do the review and perform the IVF procedures.
B. The overseeing responsible doctor will be Dr. ____ OB-GYN from Cedar City (clinic name, city, state) . The parties have agreed jointly to use a Midwife in addition to the OB. If at any time the Midwife feels there is a risk to the baby Dr ____ with be the advising doctor. Otherwise the midwife will deliver the baby either at the Intended parent’s home, in California or in a birthing center. Whichever is most appropriate and all parties are comfortable with at the time of delivery.
C. At any time that Genetic Parents are advised it is appropriate, Genetic Parents and Embryo Carrier will jointly select an infertility specialist to become the Responsible Doctor.
IV. Physical Evaluations
A. Embryo Carrier will have a medical examination, blood and other tests and psychological testing as determined by Genetic Parents and their advisors. (surrogate name) expressly waives the privilege of confidentiality and permits the release of any reports or information obtained as a result of said examination/testing (fathers name) and (mother’s name) . Embryo Carrier maintains her confidentiality with the therapy sessions involved in the surrogacy.
B. Embryo Carrier’s Husband has not had, and will not have any contact with the Embryo carrier and lives in another state and will not interfere in these proceedings in any manner.
C. Genetic Parents will have blood and STD tests as determined by the Responsible Physician. (fathers name) and (mother’s name) expressly waives the privilege of confidentiality and permits the release of any reports or information obtained as a result of said examination/testing to (Surrogate name).
V. Conditions.
All parties' obligations under this Agreement (other than the obligation of Genetic Parents to reimburse Embryo Carrier for expenses incurred) are conditioned on:
A. The approval or Genetic Parents and their advisors of results of Embryo Carrier’s exams and tests.
B. The approval of Embryo Carrier and the Responsible Physician of results of Genetic Parents STD tests.
All parties' obligations under this Agreement (other than the obligation of Genetic Parents to reimburse Embryo Carrier for expenses incurred) are conditioned on:
A. The approval or Genetic Parents and their advisors of results of Embryo Carrier’s exams and tests.
B. The approval of Embryo Carrier and the Responsible Physician of results of Genetic Parents STD tests.
VI. Medical Instructions
A. (surrogate name) agrees to adhere to all medical instructions given to her, including abstention from sexual intercourse as directed by the IVF Physician. (surrogate name) agrees to follow a transfer and prenatal medical examination schedule set by the attending Physician and Midwife.
B. Embryo Carrier will not smoke, drink alcoholic beverages, use illegal drugs, non-prescription medication or prescription medication without approval of the Responsible Physician.
C. Embryo Carrier will undergo prenatal medical exams as directed by the Responsible Physician, will submit to other medical tests, and will take only drugs and vitamins recommended or prescribed by the Responsible Physician. Which include Herbalife Multivitamins, and nutrition shakes, which she already takes.
D. Embryo Carrier will do everything reasonably appropriate for her good health and the good health of the fetus during pregnancy.
E. Embryo Carrier will not engage in any hazardous or inappropriate activity during the pregnancy.
F. Embryo Carrier will not travel outside of Utah, Nevada, California for work only and the Parent’s state if the Intended parents request it after second trimester of pregnancy, except in the event of extreme illness or death in the family (with doctors approval).
VII. IVF Procedures
It is the parties' intention to do the following:
A. Try the number of cycles recommended by the Responsible Physician, but stop at any time that the physician recommends stopping
B. Transfer a maximum of 2 embryos per cycle for the first 2 cycles. If after the first 2 cycles there is not an implanted fetus there can be an increase to 3 embryos.
VIII. Early Termination of Agreement
Before Embryo Carrier becomes pregnant, the agreement may be terminated:
A. By Genetic Parents, if the Responsible Physician's opinion is that Embryo Carrier will not become pregnant within 8 cycles.
B. By Genetic Parents, if the Responsible Physician or counselor determines that Embryo Carrier is not a good candidate for carrying out this agreement.
C. By Genetic Parents or Embryo Carrier, if Embryo Carrier has not become pregnant after 8 cycles.
D. By Embryo Carrier, if the Responsible Physician determines that Genetic Parents are not good candidates for carrying out this agreement.
E. At the discretion of Genetic Parents or Embryo Carrier.
In the event of early termination, Genetic Parents will be responsible for Embryo Carrier's costs incurred up to date of termination.
IX. Termination of Pregnancy.
The parties recognize that Embryo Carrier has the constitutional right to abort or not abort the pregnancy, however, the parties intend the following:
A. Genetic Parents and Embryo Carrier agree not to abort the pregnancy except to save the life of Embryo Carrier.
B. Genetic Parents and Embryo Carrier agree not to selectively reduce the number of fetuses in the case of a multiple pregnancy.
X. Birth
A. Location.
It is the intent of both parties that the Embryo carrier will have a water birth for the delivery of the baby either at home or at the Birthing center whichever is most appropriate at the time. OB, Dr. ___ , of (clinic name) , will oversee the pregnancy and potential birth if the Embryo Carrier cannot make it to California in time for the birth. It is the intention that the embryo carrier will travel to California and stay in California at 32 weeks for Multiples and 36 weeks for a single baby, prior to delivery and anytime that she is put on an expected long term bed rest that could lead to delivery, at the expense of the Intended parents, with the ultimate intent to deliver in California at a home birth at the Intended Parent’s home, with the assistance of a midwife.
A. Location.
It is the intent of both parties that the Embryo carrier will have a water birth for the delivery of the baby either at home or at the Birthing center whichever is most appropriate at the time. OB, Dr. ___ , of (clinic name) , will oversee the pregnancy and potential birth if the Embryo Carrier cannot make it to California in time for the birth. It is the intention that the embryo carrier will travel to California and stay in California at 32 weeks for Multiples and 36 weeks for a single baby, prior to delivery and anytime that she is put on an expected long term bed rest that could lead to delivery, at the expense of the Intended parents, with the ultimate intent to deliver in California at a home birth at the Intended Parent’s home, with the assistance of a midwife.
B. Notice of Birth.
Embryo Carrier will notify Genetic Parents as soon as she goes into labor so that Genetic Parents can join her at the place of birth. Genetic Parents intend to be present during the delivery.
C. Responsibility for Child.
Genetic Parents shall be responsible for any children born, whether healthy or not. Embryo Carrier waives the right to make medical decisions regarding the child after birth.
D. Child Born with Severe Birth Defects
If the child is born with birth defects so serious that life sustaining equipment is required and physician recommends that the child not be placed on such equipment or not be resuscitated, Genetic Parents will make the decision. If Embryo Carrier disagrees then she will be responsible for the child from that time, and Genetic Parents will have no further responsibility.
E. Name.
Genetic Parents will name the child.
F. People Attending birth
The people that attend the birth are the choice of the Embryo
Carrier. It is her intent that the
Genetic Parents will attend the birth, midwife and her assistant’s, her doula,
and a birthing photographer.
XI. Relinquishment/Adoption.
Embryo Carrier will relinquish physical custody of the child to Genetic Parents upon birth. Embryo Carrier and Genetic Parents will cooperate in all proceedings for adoption of the child by Genetic Parents.
XII. Paternity test.
Embryo Carrier, Embryo Carrier’s Husband and Genetic Parents agree that the child will have paternity tests, if Genetic Parents request.
XIII. After Birth Contact.
A. Embryo Carrier can see the child while in the hospital, but the child will be in the care of Genetic Parents from birth forward.
B. After Genetic Parents take the child from the hospital, Embryo Carrier. Genetic Parents will keep Embryo Carrier informed by sending a picture and a letter about the child’s progress at least on an annual basis. Embryo Carrier agrees that she will be reasonably available if child has questions about his/her birth mother.
XIV. Counseling
A. Counseling Sessions
It is the parties' intention that Embryo Carrier will attend at least 1 counseling sessions per month with the Responsible Counselor in Utah during the pregnancy. It is also the parties' intention that Embryo Carrier will attend more counseling sessions if:
(i) Embryo Carrier wants to attend the sessions;
(ii) Genetic Parents want Embryo Carrier to attend the sessions; or
(iii) Embryo Carrier's attendance is strongly recommended by the Responsible Counselor.
Embryo Carrier will use her reasonable efforts to attend the meetings, but will not be penalized for not attending if she does not feel well.
B. Disagreements.
The parties intend that if they have disagreements among them that they are unable to resolve quickly or if there are issues that they want to bring up before a third party, that they will discuss the disagreements or issues in a conference call or meeting under the direction of the Responsible Counselor. The parties acknowledge that the Responsible Counselor is very experienced in surrogacy matters and agree to be guided by her recommendations.
XV. Fees, Reimbursement, Insurance, and Other Expenses
A. Embryo Carrier’s Fee
1. Genetic Parents agree to pay Embryo Carrier as compensation for services provided the sum of $____ . The compensation shall be paid in 10 equal monthly installments, the first being paid after the pregnancy is confirmed.
2. In the case of a multiple pregnancy, Genetic Parents agree to pay Embryo Carrier a bonus fee of $4,000 per additional child. Bonus fee will be added to the original fee of $______ and disbursed in equal monthly installments.
3. Escrow Account - Genetic Parents will open an escrow account and will place all fees in the account before IVF procedures begin. Genetic Parents’ attorney will be authorized to disburse funds from the account per the payment schedule set out above (Section XV, Part A, Paragraph 1 and 2). All other Fee’s as described in the remaining parts of this contract will be paid to the recipient of the fee within 2 weeks of the Genetic carrier reporting the expense with receipt (for reimbursement) or bill to the Genetic parents.
4. Embryo Carrier will receive the total fees set out above (Section XV, Part A, Paragraph 1 and 2), provided she carries the child(ren) at least 32 weeks for a single, 28 weeks if multiples.
5. In the event that a cesarean is ordered in either a single or multiple birth, Embryo Carrier will be paid an additional $3000.
6. Genetic Parents will place $5,000 in the aforementioned escrow account (v) to pay for any medical expenses not covered by insurance.
7. For a completed cycle that does not result in a pregnancy, Embryo Carrier will be paid a sum of $1000.
A. Embryo Carrier’s Fee
1. Genetic Parents agree to pay Embryo Carrier as compensation for services provided the sum of $____ . The compensation shall be paid in 10 equal monthly installments, the first being paid after the pregnancy is confirmed.
2. In the case of a multiple pregnancy, Genetic Parents agree to pay Embryo Carrier a bonus fee of $4,000 per additional child. Bonus fee will be added to the original fee of $______ and disbursed in equal monthly installments.
3. Escrow Account - Genetic Parents will open an escrow account and will place all fees in the account before IVF procedures begin. Genetic Parents’ attorney will be authorized to disburse funds from the account per the payment schedule set out above (Section XV, Part A, Paragraph 1 and 2). All other Fee’s as described in the remaining parts of this contract will be paid to the recipient of the fee within 2 weeks of the Genetic carrier reporting the expense with receipt (for reimbursement) or bill to the Genetic parents.
4. Embryo Carrier will receive the total fees set out above (Section XV, Part A, Paragraph 1 and 2), provided she carries the child(ren) at least 32 weeks for a single, 28 weeks if multiples.
5. In the event that a cesarean is ordered in either a single or multiple birth, Embryo Carrier will be paid an additional $3000.
6. Genetic Parents will place $5,000 in the aforementioned escrow account (v) to pay for any medical expenses not covered by insurance.
7. For a completed cycle that does not result in a pregnancy, Embryo Carrier will be paid a sum of $1000.
8. Loss of any female reproductive organs is $5000 paid at
time of loss.
9.. Invasive
procedures (each procedure is separate, regardless if they are performed on the
same day) are to include amniocentesis (per sac), cerclage, CVS or ectopic
pregnancy with or without tubal removal, DNC undergoes or experiences a
miscarriage with a clinical abortion), HSG, SIS, selective reduction,
hysteroscopy, termination, abortion prior to 12 weeks are $750. As well as any Post-partum
Invasive procedures relating to the pregnancy and/or delivery are included up
to eight (8) weeks after delivery or termination of pregnancy.
B. Termination of Pregnancy
1. If Embryo Carrier miscarries (through no fault of her own) or is advised by by the Responsible Physician that an abortion is necessary to save her own life, then the payment plan outlined in Section XV, Part A, will cease and all payments to date will belong to Embryo Carrier. Any outstanding uninsured or unreimbursed medical expenses will be the responsibility of the Genetic Parents.
2. If Embryo Carrier aborts the pregnancy when not directed to do so by the Responsible Physician and Genetic Parents, Genetic Parents will have no responsibility for surrogacy fee or expenses other than Embryo Carrier's expenses incurred to that date.
C. Insurance
1. Genetic Parents will be responsible for term life insurance for Embryo Carrier
2. The policy will be bought before the first IVF cycle and will remain in effect until 2 months after delivery or end of pregnancy. It will cost approximately $500 premium for $500,000 face amount of insurance. The beneficiaries will be Embryo Carrier's Children: (name beneficiaries) .
D. Counseling
1. Genetic Parents responsible for costs of psychological screening for Embryo Carrier.
2. Genetic Parents responsible for costs of counseling for Embryo Carrier.
3. Genetic Parents responsible for up to 5 counseling sessions for Embryo Carrier with the Responsible Counselor after the birth, if needed.
E. Medical Payments.
1. Genetic Parents responsible for the reasonable costs of medical screening for Embryo Carrier, Genetic Mother and Genetic Father.
2. Genetic Parents responsible for all medical costs related to conception, pregnancy and birth not covered by medical insurance. Including but not limited to, Fertility specialists, specialized physicians, Hospital stays, medical testing, Midwife, and chiropractic care.
3. If a medical specialist for high-risk pregnancy is recommended by the Responsible Physician and not covered by insurance, Genetic Parents will be responsible for all related costs.
F. Attorney's Fees.
Genetic Parents responsible for their Attorney’s fee’s and the Embryo Carrier's attorney's fees for all proceedings regarding the Surrogacy including but not limited to contract’s, mediation, adoption and litigation.
G. Other Payments
1. Reimbursement for child care expenses related to Embryo Carrier's travels to doctor visits. ($10/hr or $75/day for overnight care)
2. Reimbursement for gas and travel expenses at $.45 per mile for car, airline tickets, and hotel in connection with doctor, delivery, counseling visits or any other travel incurred due to the pregnancy.
3. Household helper: Genetic Parents will provide $100 per week in the case of multiple pregnancy or high-risk pregnancy in which the Responsible physician requires Embryo Carrier to be on bed rest or drastically reduce her activity or Housekeeping allowance of $50 every week beginning the 1st day of the third trimester of pregnancy ending 4 weeks after delivery of a child.
4. Maternity clothing allowance of $500.00 is payable upon reaching 12 weeks gestation. An additional $250 for multiples is allowed at 24 weeks gestation.
5. Stillborn
Genetic Parents will be responsible for any funeral or cremation expenses.
6. Genetic Parents are not responsible for any
charges or costs unless provided for in this Agreement.
XVI. Other Issues
A. Publicity/Confidentiality.
1. Embryo Carrier will not disclose information about Genetic Parents or about this arrangement to the media unless Genetic Parents approve the disclosure.
2. Genetic Parents will not disclose information about Embryo Carrier or about this arrangement to the media unless Embryo Carrier approves the disclosure.
3. Both parties advance agree to allowing each other to write
about their experience via twitter, Facebook, any social media site or any
public blogging site as long as the other party keeps the confidentiality of
the other party’s name and identifying information. Unless the other party
reveals themselves on that media as to whom they are. With the main intent of
allowing both parties friends and family to be able to be supportive, stay in
touch with and be educated on the entire process. All posts are to be positive in tone and
never allowed to be demeaning, negative or slanderous in manner.
B. Death of Genetic Mother or Genetic Father Precedes Birth of Child(ren)
1. If Genetic Father should die before child is born, the child shall be placed with Genetic Mother as the mother, and all terms of this Agreement continue.
2. If Genetic Mother should die before child is born, the child shall be placed with Genetic Father as the father, and all terms of this Agreement continue.
3. If both Genetic Mother and Genetic Father should die before child is born, they have chosen __________________ to be child's guardian and take custody at birth.
4. In the event of the death of both Genetic Mother and Genetic Father, ________________ will be responsible for all expenses related to the surrogacy.
XVII. Arbitration
Any and all disputes relating to this Agreement or breach thereof shall be settled by arbitration in by Utah State Court Mediator Jodie Jones 146 N Stone Mountain Dr. St George UT 84770, Phone # (435) 632-3136 or (435) 628-3166 in accordance with then current rules of the American Arbitration Association, and judgment upon the award entered by the arbitrators may be entered in any Court having jurisdiction hereto. Costs of arbitration, including reasonable attorney's to the prevailing party by the Party designated by the Arbitrator or Court. Should one party either dismiss or abandon the claim or counterclaim before hearing thereon, the other Party shall be deemed the "Prevailing Party" pursuant to this Agreement. Should both parties receive judgment or award on their respective claims, the party in whose favor the larger judgment or award is rendered shall be deemed the "Prevailing Party" pursuant to this Agreement.
Any and all disputes relating to this Agreement or breach thereof shall be settled by arbitration in by Utah State Court Mediator Jodie Jones 146 N Stone Mountain Dr. St George UT 84770, Phone # (435) 632-3136 or (435) 628-3166 in accordance with then current rules of the American Arbitration Association, and judgment upon the award entered by the arbitrators may be entered in any Court having jurisdiction hereto. Costs of arbitration, including reasonable attorney's to the prevailing party by the Party designated by the Arbitrator or Court. Should one party either dismiss or abandon the claim or counterclaim before hearing thereon, the other Party shall be deemed the "Prevailing Party" pursuant to this Agreement. Should both parties receive judgment or award on their respective claims, the party in whose favor the larger judgment or award is rendered shall be deemed the "Prevailing Party" pursuant to this Agreement.
XVIII. SIGNATURES
Successors & Assigns:
This agreement shall insure to the benefit of and be binding on the parties, their heirs, personal representatives, successors and assigns. IN WITNESS WHEREOF, the parties have executed this agreement on the date first written above.
Dated this _____ day of _____, _____ at _____________________, ________
Successors & Assigns:
This agreement shall insure to the benefit of and be binding on the parties, their heirs, personal representatives, successors and assigns. IN WITNESS WHEREOF, the parties have executed this agreement on the date first written above.
Dated this _____ day of _____, _____ at _____________________, ________
____________________________________,
Embryo Carrier
By: (surrogate name)
By: (surrogate name)
NOTARY
State of _____________ County
of______________________________
I, ___________________________________,
a Notary Public of said County,
Do certify that the foregoing contract
was acknowledged before me on the
_____________day
of_____________________, 20____.
Given under my hand this
____________day of ______________, 20_____.
My commission expires:
_________________/__________________________________
Date Signature of
Notary Public
____________________________________, Genetic Father
By: (fathers name)
NOTARY
State of _____________ County
of______________________________
I, ___________________________________,
a Notary Public of said County,
Do certify that the foregoing contract
was acknowledged before me on the
_____________day
of_____________________, 20____.
Given under my hand this
____________day of ______________, 20_____.
My commission expires:
_________________/__________________________________
Date Signature of
Notary Public
____________________________________, Genetic
Mother
By: (mother’s name)
NOTARY
By: (mother’s name)
NOTARY
State of _____________ County
of______________________________
I, ___________________________________,
a Notary Public of said County,
Do certify that the foregoing contract
was acknowledged before me on the
_____________day
of_____________________, 20____.
Given under my hand this
____________day of ______________, 20_____.
My commission expires:
_________________/__________________________________
Date Signature of Notary Public
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