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Donor Agreement
This agreement is made this ____ day of ___________, 20__, by and between of , , hereafter referred to as "Recipient" and of , , , hereafter referred to as "Donor."
NOW, THEREFORE, in consideration of the promises of each other, Donor and Recipient agree as follows:
Each clause of this agreement is separate from the others and should a court refuse to enforce one or more clauses of this agreement, the others are still valid and in full force.
| 1. | Donor agrees and understands that the purpose of the insemination is to produce a child or children. |
| 2. | is a single person. is legally married. |
| 3. | Recipient agrees to pay for Donor's physical and genetic examinationDonor agrees to be tested for sexually transmitted diseases including the human immunodeficiency virus (HIV). A copy of the Donor's examination and testing results shall be provided to Recipient prior to insemination. If the medical examination and testing reveal that the Donor has a sexually transmitted disease or may transmit a genetic defect, Recipient may cancel this agreement by giving notice of such cancellation to Donor. |
| 5. | Recipient and Donor agree that Recipient has relinquished any and all rights that she might otherwise have to hold Donor legally and financially responsible for any child or children who result from the artificial insemination procedure. Each party agrees the sperm donor shall not be named as the father on the birth certificate of any child or children born from the artificial insemination. |
| 6. | of , , agrees to collect semen from Donor and to perform the artificial insemination. |
| 7. | Each party acknowledges and agrees that she or he signed this agreement voluntarily and freely, of his or her own choice, without any duress of any kind whatsoever. It also is agreed that both parties sought the advice of an attorneyIt is further acknowledged that each party understands the meaning and significance of each provision of this agreement. |
| 8. | There are no promises, understandings or agreements between the parties other than those expressly stated in this agreement. |
| 9. | This agreement shall be construed under and in accordance with the laws of the State of . |
| ______________________________ | ________________________ |
| Signature of Recipient | Date |
| ______________________________ | ________________________ |
| Signature of Donor | Date |
| ______________________________ | ________________________ |
| Signature of Physician | Date |
On this _____ day of ____________________, _____, before me, ______________________________, the undersigned officer, personally appeared _______________________________________________________________________, known to me (or proved to me on the oath of ______________________________) to be the persons who are described in and who executed the within and foregoing instrument, and acknowledged to me that they executed the same.
Before me, a Notary Public (or justice of the peace) in and for said county, personally appeared the above named _______________________________________________________________________, who acknowledged that they did sign the foregoing instrument, and that the same is their free act and deed. In testimony whereof, I have hereunto subscribed my name at ________________________________, this _____ day of ____________________, _____.
The foregoing instrument was acknowledged before me this _____ day of ____________________, _____, by _______________________________________________________________________.
The foregoing instrument was acknowledged before me, by means of ☐ physical presence or ☐ online notarization, this _____ day of ____________________, _____ by _______________________________________________________________________, who are personally known to me or who have produced ________________________________ as identification.
This instrument was acknowledged before me on this _____ day of ____________________, _____ by _______________________________________________________________________.
On this _____ day of ____________________, _____, before me personally appeared _______________________________________________________________________, to me known to be the persons described in and who executed the foregoing instrument, and acknowledged that they executed same as their free act and deed.
On this _____ day of ____________________, _____, before me, ________________________________, personally appeared _______________________________________________________________________, known to me (or satisfactorily proven) to be the persons whose names are subscribed to the within instrument and acknowledged that they executed the same as for the purposes therein contained.
On this _____ day of ____________________, _____, before me, the undersigned, Notary Public for the State of Vermont, personally appeared _______________________________________________________________________, to me known (or to me proved) to be the identical persons named in and who executed the above Premarital Agreement, and acknowledged that such persons executed it as such persons' voluntary act and deed.
The foregoing instrument was acknowledged before me this _____ day of ____________________, _____, by _______________________________________________________________________.
In witness whereof I hereunto set my hand and official seal.
Notary Public
Signature of person taking acknowledgment
_________________________________
Name typed, printed, or stamped
Title (and Rank)
_________________________________
Title or rank
My commission expires _____________
_________________________________
Serial number (if applicable)
Serial number, if any
Notary Address:
_________________________________
_________________________________
_________________________________
_________________________________
