Building your family and future
* If you have been both an egg donor and a surrogate mother, select either Egg donor or Surrogate mother and fill the corresponding Profile Submission ID.
** Please make sure E-mail Address and Phone Number to be consistent with your application of Profile Submission ID.
| I, as an Egg Donor, declare that I have examined the filled information in my Egg Donor Application, and to the best of my knowledge and belief, they are true, correct, and complete. I pledge that I have thoroughly read, understood, and fully agree with the information disclosed and the responsibilities described on the website owned by Dawner Medical Services, LLC. I, as an Egg Donor, affirm that my participation as an Egg Donor is completely voluntary and free from any influence or pressure from any other individual or party. I attest to notify Dawner Medical Services, LLC, if I no longer intend to or am unable to participate as an Egg Donor, or I become matched as an Egg Donor via another egg donor agency or a fertility clinic. I, as an Egg Donor, give my permission to Dawner Medical Services, LLC, to release my photos, videos and donor profile (including age, residence State (Country), and information in sections of General Information, Education and Employment, Medical History, Reproductive History, Personality, and Family) but without personal identification information (including name, address, phone number, email, current employer, and emergency contact), electronically, telephonically, in hard copy, or by mail, to prospective intended parents, or contractors and agents who representing intended parents. I acknowledge that information disclosed in my Egg Donor Application, including personal identification information (including First name, Last name, Birth date, current employer, and contact information), may be transmitted to third parties, after a potential match with a recipient couple has been made, including but not limited to medical clinics, reproductive attorneys and psychological evaluators, in order to complete the egg donation process. |
I, as a Surrogate Mother, declare that I have examined the filled information in my Surrogate Application, and to the best of my knowledge and belief, they are true, correct, and complete. I pledge that I have thoroughly read, understood, and fully agree with the information disclosed and the responsibilities described on the website owned by Dawner Medical Services, LLC.
I, as a Surrogate Mother, affirm that my participation as a Surrogate Mother is completely voluntary and free from any influence or pressure from any other individual or party. I shall notify Dawner Medical Services, LLC, if I no longer intend to or am unable to participate as a Surrogate Mother, or I become matched as a Surrogate Mother via another agency, individual or a fertility clinic.
I, as a Surrogate Mother, give my permission to Dawner Medical Services, LLC, to release my photos, videos and donor profile (including age, residence State (Country), and information in sections of General Information, Education and Employment, Medical History, Reproductive History, Survey on Gestational Carrying, Personality, and Family) but without personal identification information (including name, address, phone number, email, current employer, and emergency contact), electronically, telephonically, in hard copy, or by mail, to prospective intended parents, or contractors and agents who representing proespective intended parents. I acknowledge that information disclosed in my Surrogate Application, including personal identification information (including First name, Last name, Birth date, current employer, and contact information), may be transmitted to Intended Parent or other third parties, after a potential match with an Intended Parent has been made, which includes but is not limited to medical clinics, reproductive attorneys and psychological evaluators, in order to accomplish the requisite surrogacy screening and medical process.
I, as a Surrogate Mother, understand Dawner Medical Services, LLC will perform a background check, which may include criminal history, education and employment verification, credit background, and reference check, on both Surrogate Mother and her partner (if applicable) and I am willing to cooperate and submit all information as needed to conduct the background check. A color copy of government-issued photo identification documents (including passport, state-issued driver’s license/ID card, and social security card) of both Surrogate Mother and her partner (if applicable) will be required.
| I, as a Sperm Donor, declare that I have examined the filled information in my Sperm Donor Application, and to the best of my knowledge and belief, they are true, correct, and complete. I pledge that I have thoroughly read, understood, and fully agree with the information disclosed and the responsibilities described on the website owned by Dawner Medical Services, LLC. I, as a Sperm Donor, affirm that my participation as an Sperm Donor is completely voluntary and free from any influence or pressure from any other individual or party. I attest to notify Dawner Medical Services, LLC, if I no longer intend to or am unable to participate as a Sperm Donor, or I become matched as a Sperm Donor via another sperm donor agency or a fertility clinic. I, as a Sperm Donor, give my permission to Dawner Medical Services, LLC, to release my photos, videos and donor profile (including age, residence State (Country), and information in sections of General Information, Education and Employment, Medical History, Reproductive History, Personality, and Family) but without personal identification information (including name, address, phone number, email, current employer, and emergency contact), electronically, telephonically, in hard copy, or by mail, to prospective intended parents, or contractors and agents who representing intended parents. I acknowledge that information disclosed in my Sperm Donor Application, including personal identification information (including First name, Last name, Birth date, current employer, and contact information), may be transmitted to third parties, after a potential match with a recipient couple has been made, including but not limited to medical clinics, reproductive attorneys and psychological evaluators, in order to complete the sperm donation process. |