Surrogate Agreement Surrogate Agreement Surrogate Agreement 2026 Mail: PO Box 6659 . Santa Maria . CA . 93456 Lead Case Manager Dannielle Jarnesky: 805-748-9364..... Fax: 805-980-4459 www.CentralCoastSurrogacy.com Surrogate/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 aids 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 the Surrogate, the Surrogate 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 Surrogate 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 Surrogate’s contractual obligations with the Intended Parents. The Surrogate agrees not to use nicotine, marijuana, or any illicit or drug that is not prescribed by a physician during their time as a surrogate. The surrogate further agrees not to consume alcohol prior to any medical clearance appointment, while in cycle, or when pregnant. The Surrogate understands that the financial obligations arising from the surrogacy process will be set forth in a contract between the Surrogate and the Intended Parents and that the Intended Parents, and not CCS will be responsible for such obligations. The Surrogate declares that all information provided to CCS in connection with the surrogacy process is complete and accurate to the best of the Surrogate’s knowledge. The Surrogate will inform CCS as soon as possible if it is discovered that any information is inaccurate or incomplete. The Surrogate understands that as a part of the surrogacy process CCS will need to share said information provided by the Surrogate to mental health, medical, and legal professionals and to the insurance company and Intended Parents. The Surrogate further understands that the information obtained from CCS questionnaires, previous records, mental health, medical, legal and insurance professionals regarding the Surrogate 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 Surrogate, by signing this document, authorizes Central Coast Surrogacy staff to access said records for the intent of surrogacy and to release said information to such professionals as deemed appropriate for the 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 Surrogate agrees to sign any additional releases if necessary or required. The Surrogate acknowledges that CCS cannot represent or warrant the accuracy of completeness of any information provided to her by, or regarding the Intended Parents. The Surrogate further acknowledges that CCS may not share with the Surrogate 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 Surrogate 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 Surrogate also realizes that if the Intended Parents are a couple, there is no guarantee that the couple may not separate or divorce during the surrogacy process. The Surrogate understands that she is not an employee, agent or representative of CCS or the Intended Parent. The Surrogate further understands that the tax responsibilities arising in connection with payments received in connection to the surrogacy process is the responsibility of the Surrogate to seek advice from a tax specialist if she has any tax questions or issues at her own expense. The Surrogate promises that she will conduct herself with maturity and sensitivity and understands that acting as a Surrogate will require extraordinary commitment and dedication. The Surrogate agrees to use her best efforts to fulfill all her obligations arising in connection with the surrogacy 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 Surrogate, not CCS, may be liable. The Surrogate agrees to and understands 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 damage once shared by self, surrogate, or parents. The Surrogate understands that by signing this Agreement, she is agreeing to make herself available to serve as a Surrogate for Central Coast Surrogacy, LLC for a minimum of four months from the signing of this form. The Surrogate understands that her questionnaire may be submitted to various Intended Parents, and if selected, the Surrogate will be expected to commence a surrogacy arrangement with that couple or person immediately once she agrees to said match. The Surrogate understands and agrees that violation of these terms will constitute grounds of removal from CCS surrogacy program and can expose the Surrogate 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 BYSurrogate’s NameDateSurrogate’s Signature*This form should be printed and the bottom of each page initialed. This form can be scanned and emailed back, faxed in, or mailed to the address at the top of the form.
