All information provided in this application is true, accurate, complete and to the best of my knowledge.

Gestational Carrier hereby acknowledges that:

A. Reproductive Possibilities, LLC did not influence, induce or coerce me in my decision to become a gestational carrier;

B. Reproductive Possibilities, LLC is not a party to my agreement with the intended parents;

C. Reproductive Possibilities, LLC cannot predict the future behavior of the intended parents and has not guaranteed or warranted that the intended parents will comply with the terms of any agreement; and

D. Reproductive Possibilities, LLC may be providing this application to potential parents both through hard copy and electronic formats. I acknowledge and agree that I will not be notified of such mailings and hereby consent to the distribution of my application and photos to potential parents via mail and through electronic media such as email.

Therefore, I hereby agree to release and discharge Reproductive Possibilities, LLC and any of its representatives, agents, employees and servants from all liability and all manners of action, suits, causes of actions, proceedings, debts, contracts, judgments, damages, claims and demands whatsoever in law or equity in connection with my decision to become a gestational carrier or any adverse consequences which may arise in my connection with or as a result of my participation in this process. I hereby further agree to indemnify Reproductive Possibilities, LLC against any and all costs incurred in defending any such actions arising out of this process.

CONSENT OF GESTATIONAL CARRIER

Gestational Carrier and Reproductive Possibilities, LLC are entering into an agreement whereby Reproductive Possibilities, LLC will attempt to match Gestational Carrier with Intended Parents for the purpose of Gestational Carrier carrying and delivering a child for those Intended Parents.

Gestational Carrier understands that Reproductive Possibilities, LLC is not a medical facility, does not employ any doctors or medical staff, and does not provide any medical advice to Gestational Carrier. Reproductive Possibilities, LLC is not advising the Gestational Carrier of the risks associated with pregnancy. Nor does Reproductive Possibilities, LLC make any representations as to the fitness of the Gestational Carrier to carry a pregnancy.

Gestational Carrier understands that there is some possibility that there will be medical expenses incurred as a result of her pregnancy for the Intended Parents which will not be covered by any health insurance carrier. Gestational Carrier further understands that, while the Gestational Carrier Agreement executed between the Gestational Carrier and the Intended Parents may require Intended Parents to pay these uncovered medical expenses, Reproductive Possibilities, LLC cannot guarantee that the Gestational Carrier Agreement will be enforced and/or that these expenses will be paid by the Intended Parents.

Gestational Carrier understands that Reproductive Possibilities, LLC is not providing legal advice or any legal services to Gestational Carrier. At no time will Reproductive Possibilities, LLC represent the Gestational Carrier or make legal representations to the Gestational Carrier. At all times, Reproductive Possibilities, LLC solely represents the interests of the Intended Parents. However, Reproductive Possibilities, LLC will assist Gestational Carrier in locating and contacting independent legal counsel to review the Gestational Carrier Agreement. The costs associated with the independent legal counsel’s review of the Gestational Carrier Agreement will paid in full by the Intended Parents. Gestational Carrier understands that she has the right to select and pay the costs of her own independent legal counsel.

Gestational Carrier understands that Surrogate Fund Management, LLC will open and maintain an escrow account on behalf of Intended Parents. Surrogate Fund Management will make payments to Gestational Carrier from the funds in the escrow account; however, neither Surrogate Fund Management, LLC nor Reproductive Possibilities, LLC can or will act as guarantor of the monies due to Gestational Carrier.

Having been informed of all of the above, Gestational Carrier consents and desires to enter into a contractual arrangement with Reproductive Possibilities, LLC for the purpose of matching Gestational Carrier with Intended Parents and carrying and delivering a child for Intended Parents.