Embryo Donation Agreement -
Sample 3



The sample agreement/contract available here is for informational purposes only and should not be use as a replacement for legal representation.



AGREEMENT

Come now the parties, ___________________ and ___________________, hereinafter referred to as "donors," and ____________________ and ____________________, hereinafter referred to as "donees," and enter into this Embryo Transfer Agreement as follows:

1)    The donors had embryos cryopreserved which are currently in the custody of ______(clinic where embryos are stored)______________ and now desire to donate these embryos to the donees.

2)     Donors agree and understand that the embryos they are donating will be used for the purpose of causing a pregnancy by embryo donation transfer to the donees.

3)     The donors agree to ship these embryos at the time and in the manner that is agreeable to both clinics from:

    (donor’s clinic name & address)   


to:

(donee’s clinic name & address)


4)    Donors request no funds from the donees, other than reimbursement for the costs associated with storing the embryos with _________________________, plus any costs associated with shipping the cryopreserved embryos from ______________________________to __________________________.

5)    Donors agree to complete requested blood work, genetic screening, and a family medical history form to be sent to __(donee’s clinic)___________.  Donors also agree to participate in a telephone interview with a representative of ________(donee’s clinic)______, if requested.

6)     Donors agree to immediately report any significant changes in the status of their health to _______(donee’s clinic)___________

7)     Donors agree to be available to the donees and any children resulting from this embryo donation to answer questions concerning the personal and family health history of either donor.

    8)    Donors agree to relinquish all present and future rights in said embryos, or any derivations therefrom, to Donees.
   
9)     The embryos donated include: ____ embryos  which were cryopreserved on __________________.

       10)     The parties hereby acknowledge that this agreement shall be formed in the Commonwealth of Virginia.  This agreement is to be interpreted and governed in accordance with Virginia law, including but not limited to, Va. Code Ann. §§20-156-165.  All parties consent to personal jurisdiction in the federal and state courts of Virginia for any action arising out of or related to this agreement.

We certify that we have read and fully understand the above consent statement.


______________________________   _____________       September _____, 2002
Donor                   Social Security   


______________________________    _____________      September _____, 2002
Donor                   Social Security


______________________________   _____________      September _____, 2002
Donee                     Social Security


______________________________   _____________      September _____, 2002
Donee                    Social Security





State of:  ___________________
County of:  _________________

On this _____ day of _____________, 2002, _____(names of donors)_____personally appeared before me, a Notary Public in and for the jurisdiction aforesaid, and acknowledged the foregoing document to be their act and desire the same to be recorded as such. 

Witness my hand and seal the day and year aforesaid.

    My commission expires:  ____________________________


                        ___________________________________
                        Notary Public


State of:  ___________________
County of:  _________________

On this _____ day of __________, 2002, _______(names of donees)____________personally appeared before me, a Notary Public in and for the jurisdiction aforesaid, and acknowledged the foregoing document to be their act and desire the same to be recorded as such. 

Witness my hand and seal the day and year aforesaid.

    My commission expires:  ____________________________


                        ___________________________________
                        Notary Public








The Miracles Waiting, Inc. Team