Donor Name:                                                       Donor D.O.B

Address:                                                             Phone Number

Donor Email:

Declaration of Sperm Donor

 I ______________________________________________ declare that I am willing to  meet the special needs of women and that I am willing to serve as a sperm donor. I declare that I am NOT willing to meet the expectant child at 18 years.

Declaration of Standards

I _______________________________________________declare that I am willing to perform at home Natural Insemination that serves the special needs of women planning an alternative family whether single or partnered and regardless of sexual orientation.  I am willing to aggressively work to significantly reduce the barriers and limited support during Natural Insemination. I declare that I will be fully supportive and understanding of the intended parent’s unique needs.

Health Declaration

I _________________________________________ declare that I am healthy and clean and that I do not have any sexually transmittable diseases.  I declare that I have no symptoms that may be recognized as a sexually transmitted diseases such as HSV, Syphilis, herpes etc

Declaration of Payment Received

I___________________________declare that I am willing to receive $1000 after a five day natural insemination process.  I acknowledge that this $1000 includes travel feeding and all other donor expenses.

Certification

I certify that the information that I provided to the sperm recipient is correct and I authorize sperm Recipients to use it.

Donor Signature:_________________________________ Date:_________________

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