Known Sperm Donor Agreement Client Intake

Known Sperm Donor Agreement Client Intake

Provide contact details for the intended parent(s) and known donor, then answer agreement planning questions to prepare the intake.
Primary intended parent and client contact
Primary intended parent full legal name

First NameMiddle NameLast Name
Primary intended parent date of birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Primary intended parent pronouns
Primary intended parent phone number
Please enter a valid phone number.Format: (000) 000-0000.
Primary intended parent email address
example@example.com
Primary intended parent street address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Primary intended parent city
Primary intended parent state
Primary intended parent ZIP code
Is there a second intended parent?
Second intended parent full legal name

First NameMiddle NameLast Name
Second intended parent date of birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Second intended parent pronouns
Second intended parent phone number
Please enter a valid phone number.Format: (000) 000-0000.
Second intended parent email address
example@example.com
Does the second intended parent use the same address as the primary intended parent?
Second intended parent street address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Second intended parent city
Second intended parent state
Second intended parent ZIP code
Known donor
Known donor full legal name

First NameMiddle NameLast Name
Known donor date of birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Known donor pronouns
Known donor phone number
Please enter a valid phone number.Format: (000) 000-0000.
Known donor email address
example@example.com
Known donor street address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Known donor city
Known donor state
Known donor ZIP code
Known donor marital or relationship status
Relationship between donor and intended parent(s)
Agreement planning
Have any children already been conceived or born using this donor’s sperm?
If yes, provide the child(ren)’s details
Will conception occur through a licensed clinic or medical provider?
If yes, clinic or provider name
If yes, clinic or provider location

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Intended conception method
Do the intended parents and donor intend for the donor to be a legal parent?
Describe the intended future contact plan
Describe when and how donor identity will be disclosed to the child
Known genetic or hereditary conditions to address
Preferred Virginia governing law
Intended social contact or role
Who will pay medical and donation-related costs?

Other
Will the donor receive compensation beyond expense reimbursement?
If yes, describe the compensation details
Preferred dispute-resolution method
Target signing date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Anything else the attorney should know
Should be Empty:

Known Sperm Donor Agreement Client Intake

Primary intended parent and client contact

Known donor

Agreement planning