Surrogate and Husband

[Surrogate's name], surrogate, and [surrogate's husband's name], her husband, hereby agree to hold _________, or his [her] associates of _________, _________, _________ free and clear of any and all fault and/or liability in connection with the artificial insemination of [surrogate's name], surrogate, with the semen of [natural father's name], natural father. However, nothing in this release shall be construed as an attempt by the above-named physicians and or their associates to exonerate themselves or otherwise limit their liability in the event of personal malpractice.

(1). It is understood that a physician can only advise the surrogate to abstain from sexual activity. He or she cannot control or diagnose sexual relations the surrogate may have had at or about the date(s) of her insemination. A pregnancy test may not show a pregnancy if conception has only recently occurred. An HLA paternity test will show whether the semen donor is the father, it is not in any way a guarantee that the semen donor will be the father of the child born to the surrogate.

(2). It is further understood that the physician cannot be professionally responsible if the surrogate fails to keep her prenatal appointments in the event of an obstetrical problem.

[Surrogate's name], surrogate, and [surrogate's husband's name], her husband, agree to give immediate custody of the child she is to conceive and deliver to [natural father's name], its natural and biological father, as agreed in the Surrogate Parenting Agreement.




Surrogate's Husband