Egg Donor Agreement Egg Donor Agreement Egg Donor Agreement 2026 email to: dannielleccsllc@gmail.com Mail: PO Box 6659. Santa Maria. CA. 93456 Lead Case Manager Dannielle Jarnesky: 805-714-4959..... Fax: 805-980-4459 www.CentralCoastSurrogacy.com Egg Donor/Central Coast Surrogacy, LLC Agreement (Required) Central Coast Surrogacy, LLC (“CCS”) is an agency based in Santa Maria, CA, which assists individuals and couples (“Intended Parents”) in locating and selecting a suitable Egg Donor and/or Surrogate for the purpose of creating a child(ren). CCS aides the Intended Parents, Egg Donor, and Surrogate in administration of agreements, assists in coordinating all necessary medical appointments with the physician(s), the mental health professional(s), attorney(s) and other necessary professionals. CCS fees for these services are paid for by the Intended Parents. While CCS is to aid, guidance and support to the Egg Donor, the Egg Donor must realize that CCS also has commitments to the Intended Parents as well and must act in the best interest of all parties whenever possible. The Egg Donor agrees to inform Central Coast Surrogacy, LLC of all significant changes in her personal life, including, but not limited to, separation/divorce, marriage, address and telephone changes, employment changes, insurance coverage changes, and health changes, as this may affect the Egg Donor’s contractual obligations with the Intended Parents. The Egg Donor understands that the financial obligations arising from the donation process will be set forth in a contract between the Egg Donor and the Intended Parents and that the Intended Parents, and not CCS will be responsible for such obligations. The Egg Donor declares that all information provided to CCS in connection with the donation process is complete and accurate to the best of the Donor’s knowledge. The Egg Donor will inform CCS as soon as possible if it is discovered that any information is inaccurate or incomplete. The Egg Donor understands that as a part of the donor process CCS will need to share said information provided by the Egg Donor to mental health, medical, and legal professionals and to the insurance company and Intended Parents. The Egg Donor further understands that the information obtained from CCS questionnaires, previous records, mental health, medical, legal and insurance professionals regarding Egg Donor may be shared with appropriate parties including, but not limited to, CCS employees, Intended Parents, doctors, nurses, clinic coordinators, mental health professionals, insurance professionals, etc. The Egg Donor, by signing this document, authorizes Central Coast Surrogacy staff to access said records for the intent of egg donation and surrogacy and to release said information to such professionals as deemed appropriate for the donation and surrogacy process and releases CCS of all liability in connection with the gathering and releasing of all information current and future in connection with this or any future surrogacy arrangement. The Egg Donor agrees to sign any additional releases if necessary or required. The Egg Donor acknowledges that CCS cannot represent or warrant the accuracy of completeness of any information provided to her by, or regarding the Intended Parents. The Egg Donor further acknowledges that CCS may not share with the Egg Donor information of a confidential nature (that is not necessary or relevant to the surrogacy process) that has been provided to CCS by the Intended Parents. The Egg Donor understands that although CCS strongly recommends psychological screening or assessment of the Intended Parents, it is not required, and that the medical screening performed on the Intended Parents is determined by the medical professionals selected by the Intended Parents, not CCS. The Egg Donor also realizes that if the Intended Parents are a couple, there is no guarantee that the couple may not separate or divorce during the donation process. The Egg Donor understands that she is not an employee, agent or representative of CCS or the Intended Parent. The Egg Donor further understands that the tax responsibilities arising in connection with payments received in connection to the donor process is the responsibility of the Egg Donor to seek advice from a tax specialist if she has any tax questions or issues at her own expense. The Egg Donor promises that she will conduct herself with maturity and sensitivity and understands that acting as an Egg Donor will require an extraordinary commitment and dedication. The Egg Donor agrees to use her best efforts to fulfill all her obligations arising in connection with the donor process, including, but not limited to, making all necessary appointments, taking all required medications as directed, and communicating all updates to CCS, and that failing to do so may arise in a breach of contractual obligations for which the Egg Donor, not CCS, may be liable. The Egg Donor agrees to and understand that pictures sent to CCS are property of CCS and can be used on social media and sent to the Intended Parents unless otherwise told so by the Surrogate prior to posting/sending in writing. CCS is not responsible for any damages once shared by self, donor, or Intended Parents. The Egg Donor understands that by signing this Agreement, she is agreeing to make herself available to serve as an egg Donor for Central Coast Surrogacy, LLC for a minimum of four months from the signing of this form. The Egg Donor understands that her questionnaire may be submitted to various Intended Parents, and if selected, the Egg Donor will be expected to commence an egg donor arrangement with that couple or person immediately once she agrees to said match. The Egg Donor understands and agrees that violation of these terms will constitute grounds of removal from CCS surrogacy program and can expose the Egg Donor to monetary damages for expenses incurred on behalf of CCS and the Intended Parents in connections with her matching and application process. By signing this Agreement, the Egg Donor agrees to the terms and conditions set forth above and is representing she has read the warranties and representations herein, and is signing this Agreement knowingly, willingly, and voluntarily. AGREED TO AND ACCEPTED BYEgg Donor’s Name (Print)DateSignature*Please note that this form should be printed and initialed at the bottom of each page and signed at the bottom of the last page. This can be mailed in, scanned and emailed, or faxed back. If using electronic signature, please email and state you are electronically signing and understand and agree to terms.
