California Statutory Forms for Assisted Reproduction, Form 1: |
Married Spouses or Registered Domestic Partners Using Assisted
Reproduction to Conceive a Child |
Use this form if: (1) You and the other person are married spouses or registered domestic partners (including registered domestic partners or civil union partners from another jurisdiction); (2) you and the other person are conceiving a child through assisted reproduction using sperm and/or egg donation; and (3) one of you will be giving birth. |
WARNING: Signing this form does not terminate the parentage claim of a sperm donor. A sperm donor’s claim to parentage is terminated if the sperm is provided to a licensed physician or surgeon or to a licensed sperm bank prior to insemination as required by Section 7613(b) of the Family Code. |
The laws about parentage of a child are
complicated. You are strongly encouraged to consult with an attorney about your rights. Even if you do not fill out this form, a spouse or domestic partner of the parent giving birth is presumed to be a legal parent of any child born during the marriage or domestic partnership. |
This form demonstrates your intent to be parents of the child you plan to conceive through assisted reproduction using sperm and/or egg donation. |
I, ____________________ (print name of spouse/partner), am married to, or in a registered domestic partnership (including a registered domestic partnership or civil
union from another jurisdiction) with, a person who will give birth to a child we plan to conceive through assisted reproduction using sperm and/or egg donation. I consent to the use of assisted reproduction by my spouse/domestic partner to conceive a child. I INTEND to be a parent of the child conceived. |
SIGNATURES |
Intended parent who will give birth: ___________________ (print name) |
________________________ (signature) ____________(date) |
Intended parent spouse or registered domestic partner: ____________ (print name) |
_________________________ (signature) ___________(date) |
NOTARY ACKNOWLEDGMENT |
State of California |
County of )
_____
|
On before me, (insert name and title of the officer) |
personally appeared , |
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity, and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. |
I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. |
WITNESS my hand and official seal. |
Signature(Seal) |
California Statutory Forms for Assisted Reproduction, Form 2: |
Unmarried, Intended Parents Using Intended Parent’s Sperm to Conceive a Child |
Use this form if: (1) Neither you or the other person are married or in a registered domestic partnership (including a registered domestic partnership or civil union from another state); (2) one of
you will give birth to a child conceived through assisted reproduction using the intended parent’s sperm; and (3) you both intend to be parents of that child. |
Do not use this form if you are conceiving using a surrogate. |
WARNING: If you do not sign this form, you may be treated as a sperm donor if your sperm is provided to a licensed physician or surgeon or to a licensed sperm bank prior to insemination according to Section 7613(b) of the Family Code. |
The laws about parentage of a child are complicated. You are strongly encouraged to consult with an attorney about your rights. |
This form demonstrates your intent to be parents of the child you plan to conceive through assisted reproduction using sperm donation. |
I, ____________________ (print name of parent giving birth), plan to use assisted reproduction with another intended parent who is providing sperm to conceive the child. I am not married and am not in a registered domestic partnership (including a registered domestic partnership or civil union from another jurisdiction), and I INTEND for the person providing sperm to be a parent of the child to be conceived. |
I,
____________________ (print name of parent providing sperm), plan to use assisted reproduction to conceive a child using my sperm with the parent giving birth. I am not married and am not in a registered domestic partnership (including a registered domestic partnership or civil union from another jurisdiction), and I INTEND to be a parent of the child to be conceived. |
SIGNATURES |
Intended parent giving birth: ___________________ (print name) |
________________________ (signature) ____________(date) |
Intended parent providing sperm: ____________ (print name) |
_________________________ (signature) ___________(date) |
NOTARY ACKNOWLEDGMENT |
State of California |
County of )
_____
|
On before me, (insert name and title of the
officer) |
personally appeared , |
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity, and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. |
I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. |
WITNESS my hand and official seal. |
Signature(Seal) |
California Statutory Forms for Assisted Reproduction, Form 3: |
Intended Parents Conceiving a Child Using Eggs from One Parent and the Other Parent Will Give Birth |
Use this form if: You are conceiving a child using the eggs from
one of you and the other person will give birth to the child; (2) and you both intend to be parents to that child. |
Do not use this form if you are conceiving using a surrogate. |
WARNING: Signing this form does not terminate the parentage claim of a spermdonor. A sperm donor’s claim to parentage is terminated if the sperm is provided to a licensed physician or surgeon or to a licensed sperm bank prior to insemination as required by Section 7613(b) of the Family Code. |
The laws about parentage of a child are complicated. You are strongly encouraged to consult
with an attorney about your rights. |
This form demonstrates your intent to be parents of the child you plan to conceive through assisted reproduction using eggs from one parent and the other parent will give birth to the child. |
I, ____________________ (print name of parent giving birth), plan to use assisted reproduction to conceive and give birth to a child with another person who will provide eggs to conceive the child. I INTEND for the person providing eggs to be a parent of the child to be conceived. |
I, ____________________ (print name of parent providing eggs), plan to use assisted reproduction to conceive a child with another person who will give birth to the child conceived using my eggs. I INTEND to be a parent of the child to be conceived. |
SIGNATURES |
Intended parent giving birth: ___________________ (print name) |
________________________ (signature) ____________(date) |
Intended parent providing eggs: ____________ (print name) |
_________________________ (signature) ___________(date) |
NOTARY ACKNOWLEDGMENT |
State of California |
County of )
_____
|
On before me, (insert name and title of the officer) |
personally appeared , |
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity, and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. |
I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. |
WITNESS my hand and official seal. |
Signature(Seal) |