Embryo Donor Website Subscription and Ad/Profile Submission

Embryo Donor Website Subscription and Ad/Profile Submission

Thank you so much for your interest in the Miracles Waiting (Frozen Miracles) Embryo Donation Program. We are very excited to have you! Please take a moment to complete this application for our records and ad/profile submission. If you have any questions about submitting this form, please contact Paloma at: paloma@miracleswaiting.net

Your application will be reviewed and, upon acceptance you will be given full access to the restricted area of the website (our embryo donor and recipient profiles and forum).

You can expect to receive an email from us letting you know that you have access to the website's restricted area within 24 - 48 hours of receipt of your application.
We do NOT reject applications without contacting the applicant to discuss why they are being rejected. So if you do not hear from us within 72 hours, you can assume that there was some problem during the transmission of your application and you should contact us to let us know about the problem.

Please Note: Those using the Miracles Waiting (Frozen Miracles) Website cannot use Miracles Waiting (Frozen Miracles) to try to sell or buy embryos.

Also when donating or receiving embryos you should always seek legal representation to draw up an embryo donation contract so you can protect yourself and others involved from engaging in any unwillingly illegal transaction.

Sincerely,
Admin

Name * First Last
Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone *
User name you want to use with your registration at the Miracles Waiting (Frozen Miracles) Website.
At least 6 letters and 2 numbers are required. *
*The email you want to use to register and use at the Miracles Waiting Website. Gmail.com seems to work the best. We advise that you do not use a Yahoo.com email account with this website.
Some members who use a Yahoo email with Miracles Waiting have had problems receiving and sending contact emails through their ad/profile when using a Yahoo email to contact donor or recipient families.
Email: *
Please re-enter email *
Gender: *
Age Group: *
How soon do you want to donate your embryos? *
As quickly as possible Within a year Other - Please explain below
How many embryos do you have available to donate? *
Please explain briefly your interest and understanding of Embryo Donation.

Please Note: EMBRYO donation is not the same as EGG donation. *
What criterion are most important to you in a recipient? *
How did you find Miracles Waiting (Frozen Miracles)? *
Search Engine Other Website/Bulletin Board Banner Ads In the News Magazine/Newspaper My Physician Word of Mouth Other
Terms and Conditions

This subscription will give you access to the interactive areas of the site and you must agree not to post any abusive, obscene, vulgar, hateful, threatening, or any other material that may violate any applicable laws. You must also agree that you may not share your login details with anyone else. These details are for your personal use only and you understand that if you share them you can lose your privileges and access to the restricted area of the website. The ads, ads/profiles, and posts you will find at the Miracles Waiting (Frozen Miracles) website are contributed by the authors, and we do not verify the details or content for accuracy and we make no claims as to the accuracy of the information provided in them. Under no circumstances should Miracles Waiting (Frozen Miracles) be held liable for any dispute that may result from anyone’s reliance on published information or as a result of contacting one of our members through ads and/or posts. We also reserve the right to remove an ad/profile or post without warning, that violates the terms and conditions listed or otherwise injures the integrity of the website. By clicking "agree" below you agree to be bound by these conditions.
I'm older than 18 years old and I have read and agree to the terms and conditions above *
Agree Disagree
Confidentiality Agreement

This is a Confidentiality Agreement between you and Miracles Waiting (Frozen Miracles) Please read this information carefully.

Members: Except for parties to the transaction, Members agree not to disclose to any third party (including but not limited to media sources - TV, radio, website, magazine, newspaper, blog, etc.) or use in any manner information furnished by and/or at Miracles Waiting (Frozen Miracles), including but not limited to, terms of engagement, information available on the Miracles Waiting (Frozen Miracles) website, information from Miracles Waiting (Frozen Miracles) member’s ads/profiles, information obtained by members using email, phone, face to face conversation, or information sent by document delivery service to and from any of our members and obtained from the Miracles Waiting (Frozen Miracles) personnel.

Members will not disclose the confidential information to any person or party without the specific written authorization of Miracles Waiting (Frozen Miracles) and the other party.
I have read and agree to the Confidentiality Agreement above *
Agree Disagree
Electronic Signature (Type your Name) *
Partner Signature/Name (if applicable)
Today's Date: * / MM / DD YYYY
Thank You For Your Application!

Please continue with part 2 below. The information below will be used to create your donor ad/profile.
This is part 2 of your submission. The information below will be used to create your ad/profile.

Ads will be published after administrator validation. This process can take 24 - 48 hrs - longer if submitted during the weekends or holidays. Please make sure you answer as much information as possible. If you need help please contact us. Only registered, logged in members will be able to contact you through your ad/profile.
Email address you want to use with your ad/profile. You can use a different email address from the one you used with your registration information above.

Families who contact you through your ad/profile will not see your email address until you reply back to them. *
Please re-enter e-mail *
Your general area of residency.
Where do you reside? Your ad/profile will be added to the area you choose here. *
Ad/Profile Title: *
Must be between 10 and 100 characters. Currently Entered: 0 characters.
Add the introduction (greeting/welcome) to your Ad/Profile. *
Preference of living distance from recipient: *
Doesn't matter Not too far away Fairly close Far away
Infertility diagnosis or N/A: *
Name or city/state of clinic where embryos were created: *
Name or city/state of clinic/facility where embryos are stored: *
Number of embryos available in storage: *
Year frozen: *
Overall embryo batch quality : *
Stage when frozen: *
Unknown Pronucleate 2PN Morula Blastocyst Frozen on multiples days
Day frozen: *
Any children resulting from this batch of embryos? *
Yes No
Number of children born from the fresh cycle for this batch: *
None 1 2 3 4 or more Currently pregnant from this cycle
Number of children born from the frozen cycle for this batch: *
None 1 2 3 4 or more Currently pregnant from this cycle
Any other children? (If so please explain) *
Female Information: (If an egg donor was used, enter the info for the egg donor)
Was egg donor used? *
Yes No
Age at time of IVF cycle: *
Race: *
African-American Asian or Pacific Islander Caucasian Hispanic Native American/Alaskan Other
Eye color: *
Blue Brown Green Hazel Other
Hair Color: *
Black Dark Brown Medium Brown Light Brown Red Brown Red Strawberry Blonde Blond Other
Height: *
Blood type: *
A+ A- B+ B- O+ O- AB+ AB- Unknown
Education/employment background: *
Religion:
Ethnic background: (eg. German, Scottish, etc.)
Male Information: (If a sperm donor was used, enter the info for the sperm donor)
Was sperm donor used? *
Yes No
Age at time of IVF cycle: *
Race: *
African-American Asian or Pacific Islander Caucasian Hispanic Native American/Alaskan Other
Eye color: *
Blue Brown Green Hazel Other
Hair Color: *
Black Dark Brown Medium Brown Light Brown Red Brown Red Strawberry Blonde Blond Other
Height: *
Blood type: *
A+ A- B+ B- O+ O- AB+ AB- Unknown
Education/employment background: *
Religion:
Ethnic background: (eg. German, Scottish, etc.)
Hobbies/Interests/Other info (Please also clarify any answers from above or include any info you would like to share)
You can upload up to two (2) pictures to use with your ad/profile. Please know that if you submit a picture, your picture will be seen by visitors, and not just logged-in members.

Upload Picture #1
Allowed File Options: jpg, gif, png
Maximum file size: 1MB
Upload Picture #2
Allowed File Options: jpg, gif, png
Maximum file size: 1MB
Thank you!

Please let us know anything we can do to help your journey be a successful one. Your gift is a precious one, and we thank you for sharing it.
Type the letters you see in the image below.