THIS AGREEMENT by and between _______and ______ hereinafter referred to as the "Biological Mother and Father" or collectively as the "Biological Parents") and _________ (hereinafter referred to as the "Carrier").
WHEREAS, Biological Mother and Father are over the age of 18 and will attempt to conceive a child(ren) by placement of their embryo conceived by in vitro fertilization (IVF) into an appropriate uterine host hereinafter referred to as the Carrier;
WHEREAS, Biological Mother is not medically able to maintain a pregnancy, and the Biological Parents are desirous of contracting with the Carrier for such services;
WHEREAS, the Carrier is over the age of 18 and is desirous of assisting the Biological Parents in having their own biological child(ren) and in contracting with the Biological Father and Mother to provide such services;
WHEREAS, the Biological Parents and the Carrier have requested _________(the "IVF" Team) to assist them in carrying out the purpose of this Agreement.
NOW THEREFORE, in consideration of the mutual promises contained herein and with the intention of being legally bound hereby, the parties mutually agree as follows:
1. The Biological Father and Mother agree and understand that they are entering into this Agreement with the Carrier whereby the Biological Father and Mother agree to the placement of their embryo(s) conceived through IVF into the uterus of the Carrier for the purpose of impregnating the Carrier. Thereafter, assuming the Carrier becomes pregnant, the Carrier shall use her best efforts to carry the pregnancy to term and give birth to a child or children (hereinafter referred to in the singular as a "child") parented by the Biological Father and Mother. It is agreed that this procedure will be performed not more than six times, if necessary for the Carrier to become pregnant, within 18 months from the date of this Agreement.
2. It is the intent of the parties that neither the Carrier nor her husband shall have any physical or legal custody of or any parental rights or duties with respect to the child born of this gestational surrogacy process and that the Biological Parents shall exclusively have such custody and all parental rights and duties from the moment of the child's birth. Notwithstanding the foregoing or any other provision of this Agreement, it is expressly understood and agreed that this Agreement does not condition the payment of compensation or the giving of anything of value to Carrier upon the termination an any parental rights or the placement of the child with the Biological Parents. The Carrier agrees that it is in the best interests of the child that the child be raised by the Biological Parents and that the Biological Parents have full physical and legal custody of the child. Carrier further agrees that she will not at time seek to obtain custody, partial custody or visitation of the child or attempt to form any parental relationship with the child. The Carrier and Biological Parents agree that the Biological Parents will take full custody of the child as soon as is medically practicable following its birth and will bear the full cost and responsibility of caring for and raising the child. Without any consideration other than concern for the best interests and welfare of the child, the Carrier agrees that she will cooperate fully in allowing the Biological Parents to bond with and take custody of the child immediately upon birth. The Carrier further agrees to take any further lawful action necessary to enable them to do so.
3. The Biological Parents agree to pay the Carrier as compensation for the services provided the sum of $_____ following a single live birth. Within 7 days after confirmation that the Carrier is pregnant, with a detectable fetal heartbeat, the Biological Parents will establish an escrow account for such compensation. Upon the birth of a living child from the uterus of the Carrier the compensation shall be forthwith paid from the escrow account to the Carrier. The compensation shall be deposited in escrow as follows:
(A) $______upon positive medical confirmation that the Carrier is pregnant, with a detectable fetal heart beat.
(B) $______ within six months after the positive medical confirmation that the Carrier is pregnant, and if the Carrier is still pregnant.
(C) $______ into escrow if the Carrier is still pregnant, not less than thirty days prior to the anticipated delivery date.
In the event of multiple births, the Biological Parents agree to pay an additional $______per fetus directly to the Carrier at the time described above that the $______ is paid from the escrow account.
4. In addition to the compensation set forth above, the Biological Parents agree to indemnify the Carrier for:
(A) all reasonably documented incidental expenses, such as telephone toll charges, travel, parking, baby-sitters as needed (at a rate of $____ per hour), missed time from work (or spouses missed time due to surrogacy needs). A maternity clothes allowance in the amount of $______, which will be paid eight weeks after estimated conception of pregnancy. The biological parents will set up an account from which the carrier will be able to write checks, or withdraw funds for any and all incidental costs. All expenses must be fully documented with receipts.
(B) all unreimbursed and uninsured medical expenses incident to the pregnancy of the Carrier (The Carrier has confirmed to the Biological Parents that to the best of her knowledge she has medical insurance that includes maternity, and delivery benefits and the Carrier understands that the Biological Parents are relying on this information in entering into this Agreement);
(C) psychological counseling, as needed, from the date of this Agreement through the end of the third month following a live birth or until such time as this Agreement is earlier terminated;
(D) up to $____ per month for childcare and/or home care services if bed rest is advised by the Carrier's physician and the Carrier's insurance policy does not cover such child care and/or home care services; and
(E) a one-year term life insurance policy in the amount of $_____ purchased by the Biological Parents for the Carrier at the time of a confirmed pregnancy.
5. All parties agree it is important for the Carrier to receive independent legal counseling relevant to the Carrier procedure so that she is aware of potential legal problems incident to the procedure. The Carrier has been so advised by _________whose agreed fee of $____ will be paid by the Biological Parents.
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6. If the Carrier becomes pregnant but loses the pregnancy in the first trimester, (after confirmation of a detectable heart beat) compensation of $____ will be paid to the carrier. If the carrier becomes pregnant but loses the pregnancy in the second trimester, _ of the agreed upon amount of compensation will be paid to the carrier. In the event of a pre-term delivery (in the 3rd trimester), but not within one month of the due date (2 months with twins), the carrier shall be paid ____ of the agreed upon compensation amount. In the event of delivery within one month of the due date (2 months in the case of twins) total compensation shall be paid to the surrogate. All these compensation amounts shall be paid regardless of the heath/living status of the child. If the carrier incurs the loss of the child at any time, no previously paid monies of any kind shall be returned. No further payments will be made.
7. The biological parents agree to compensate the carrier $____ per transfer attempt. This does not include travel, missed time from work, or any other incidental expenses incurred as a result of the transfer attempt.
8. The biological parents agree to compensate the carrier with a $____ per month living expense through out the pregnancy. This shall begin upon detection of a heartbeat. If at anytime the carrier loses the pregnancy, this living expense compensation will cease.
9. The biological parents agree to purchase a "Homemakers Disability Policy" for the carrier, for the coverage length of one year, to take effect upon confirmation of the pregnancy.
10. The biological parents agree to provide the carrier with a private hospital room, on a floor other than the maternity floor, for her hospital stay post delivery. Carriers insurance will pay the "semiprivate" room rate for the hospital stay.
11. The Carrier, the Biological Father and Mother warrant and represent, each as to herself or himself, that to the best of his or her knowledge he or she is medically free from disease or other hereditary medical problems that could cause injury, defect or disease to the Carrier or the fetus to be carried by the Carrier.
12. The carrier will agree that a birth certificate naming the Biological Parents as parents, unless medical considerations dictate otherwise, will be issued (b) she will to the best of her ability stay in good health throughout the pregnancy, not smoke, drink alcohol or use illegal drugs and will follow the medical advice of her caring physician and submit to regular obstetrical care and standards by an obstetrician approved by Biological Parents; (c) she will permit monitoring by frequent testing for normalcy of the fetus(es) including chorionic villus sampling and, in the event the pregnancy progresses to 16 weeks, will permit an amniocentesis, for determination of chromosome status of the fetus (and the Biological Parents will have access to this information) and, if so requested by the Biological Mother or Father, genetic (DNA ) testing of the fetus(es); (d) in the event chromosomal abnormality is determined, she will permit the termination of the pregnancy at the request of the Biological Parents; (e) in the event three or more fetuses are successfully transferred, she will agree to the selective reduction of the number of fetuses to two; (f) she will abstain from sexual intercourse as recommended by the IVF team; (g) she will invite the Biological Mother to obstetrician visits (including the amniocentesis) and will notify the Biological Parents regularly about the status of her pregnancy, her expected delivery date and any changes thereof, and the actual delivery date unless emergency conditions are present; (h) she will consent to the release of her medical records to the Biological Parents' physician and/or the ______(name of fertility center or clinic); (i) she will remain in the ___________ area during the last trimester of her pregnancy, until ___ weeks before the expected due date, at which time she will travel to______ in order to deliver; and (j) she will keep this Agreement and her participation in this arrangement coincidental and non-public unless mutually agreed otherwise.
13. The Carrier shall have the right to terminate the pregnancy if her physician believes the pregnancy poses a serious risk of damage to her health.
14. This Agreement may be terminated by either the Carrier or the Biological Parents. In the event of termination, neither Carrier nor the Biological Parents shall be under any further obligation not already incurred, or not thereby incurred, under this Agreement. Any willful violation of the provisions of this Agreement by the Carrier shall result in the forfeiture of all compensation and all reimbursements otherwise due the Carrier under this Agreement. If either party sees fit to terminate this agreement, any monies already paid out will not be returned. No further payments will be made.
15. This Agreement, is binding on each party's respective executors, heirs and assigns and successors and may not be assigned by any party without the written consent of all other parties
16. If after conception, but prior to the Carrier delivering the child, the Biological Parents are no longer alive, ________________shall have permanent custody of the resultant child. The Biological Parents will revise their will accordingly prior to implantation of their embryos into the uterus of the Carrier.
17. Each party acknowledges that he or she has fully ready the Agreement, is relying on the representations set forth in this Agreement, is signing the same freely and voluntarily and has no reason to believe that the others did not understand fully the terms and effects of this Agreement or freely and voluntarily execute this Agreement
18. The Agreement as been drafted, negotiated and executed in North Carolina, and shall be governed by, construed and enforced in accordance with the laws of the State of North Carolina.
19. This is the entire Agreement among the parties and any modification of subsequent agreement must be in writing and signed by all parties. This Agreement may be executed in counterparts.
20. In the event any of the provisions of this Agreement are deemed to be invalid or unenforceable, the same shall be deemed severable from the remainder of this Agreement. If such provision(s) shall be deemed invalid due to its scope or breadth, then said provision(s) shall be deemed valid to the extent of the scope or breadth permitted by law.
__________________________________
Biological Father
_______________________________
Date
__________________________________
Biological Mother
_______________________________
Date
__________________________________
Carrier
_______________________________
Date
I, ________________, hereby acknowledge that I have agreed to carry and give birth to a child conceived via in vitro fertilization through the union of _______ ovum/ova _______sperm, so that ___________________may have a child genetically related to them. I have no intention of having physical or legal custody or any parental rights or duties with respect to any child born of this gestational surrogacy process. Rather, it is my intention that the genetic and intended parents__________, shall exclusively have such custody and all parental rights and duties.
I further acknowledge that it is in the best interests of the child born of this gestational surrogacy process for ____________to have sole custody of said child. I therefore, agree to cooperate fully in allowing them to bond with and take custody of said child from the moment of its birth.
__________________________________
Carrier
_______________________________
Date
I, _________, hereby acknowledge that I am over eighteen years of age and have read and fully understand the foregoing Gestational Surrogacy Agreement among my wife and______________, including all attachments thereto.
I further acknowledge that I am in full agreement with the objectives of the Agreement and fully support the terms and provisions thereof. I hereby agree to cooperate with and assist my wife in fulfilling her obligations under said Agreement. Such cooperation shall include but not be limited to abstaining from sexual intercourse with my wife during the times the __________instructs.
I understand that, as I will not be the biological father of the child or children here boor of this gestational surrogacy process, I shall at no time attempt to assert a any parental rights or seek any kind of custody or visitation with respect to said child and that it is intended that __________as the intended and genetic parents of the child, shall exclusively have full physical and legal custody and all parental rights I understand and agree that it is in the best interest of said child that I not attempt to form any parental relationship with him/her, and immediately upon the birth of said child, I shall cooperate fully in allowing the Biological Parents to bond with and take custody of him/her.
I agree, in order to effectuate the intend and objectives of this Agree to (I) cooperate in all proceedings which may be necessary or desirable, (ii) sign any and all affidavits and or documents, which I can truthfully sign, requested at any time by the Biological Parents including but not limited to an Affidavit of Non-Access and or an Affidavit of Non-paternity and (iii) assist in having the genetic and intended father _______listed on all documents as the father of said child.
I agree that, unless expressly permitted to do so by both Carrier and Biological Parents, I shall no pro vide nor allow any agent of mine to provide any information to the public new media or any other individual or group which could lead to the disclosure of the identity of any party to the Agreement or said child or which reveals the provisions of this affidavit of the Agreement
I hereby acknowledge that I read and understand the foregoing and intend to be legally bound thereby.
__________________________________
Carrier's Husband
_______________________________
Date
