Please fill out this application, and submit to Canadian Surrogacy Community.
Once approved you will be required to provide 8-10 photos of yourself and/or your family.

All information is kept completely confidential except for purposes related to surrogacy/egg donation services.
Therefore, this information will only be shared with potential Intended Parents, physicians, and mental health providers as needed.

(Photocopies of your identifying information/full address will not be disclosed and kept strictly confidential unless requested otherwise).

RELEASE AND INDEMNIFICATION

I/We, (referred to as “Surrogate Mother Applicant”) AND (referred to as “Spouse/Partner of Surrogate
Mother applicant”) ACKNOWLEDGE, AGREE AND SWEAR TO THE FOLLOWING TERMS
1. It is my/our desire to enter into a surrogacy arrangement with individuals who desire to become parents.
2. Canadian Surrogacy Community did not coerce, induce or unduly influence my/our decision to apply to
be a surrogate mother.
3. Canadian Surrogacy Community does not represent me/us or will be providing us with legal or medical
counsel.
4. Canadian Surrogacy Community is not party to any agreement that I/we may enter into with intended parents.
5. Canadian Surrogacy Community makes no representations, warranties or guarantees regarding the intended parents and the surrogacy process and I/we understand and agree that they cannot predict or control the intended parents or how a court may interpret or enforce any surrogacy agreement I/we may enter into with intended parents. Furthermore, I/we acknowledge that Canadian Surrogacy Community, their employees and representatives do not have the authority or ability to predict or control my/our actions, conduct, negligence, or my/our failures to act nor the authority or ability to predict or control the actions, conduct, negligence, or failure to act of the intended parents.
6. Canadian Surrogacy Community will be providing my/our application and the information I/we provided with it to prospective intended parents electronically and/or in print. I/We acknowledge that Canadian Surrogacy Community provides my/our information to prospective intended parents and hereby consent to my/our application and related information being provided electronically and/or in print.
7. I/We hereby release and discharge Canadian Surrogacy Community, their employees and representatives from all liability and all manners of action, suits, causes of actions, proceedings, debts, claims, an demands whatsoever in law or equity resulting from my/our decision to be a surrogate mother and any adverse consequences or damages that may result from my/our involvement with the surrogacy process.
8. I/We have had the opportunity to consult with legal counsel regarding this Release and Indemnification and have done so or have decided on my/our own accord not to consult with legal counsel.
I/WE, THE UNDERSIGNED, HAVE READ THE ABOVE RELEASE AND INDEMNIFICATION. I/WE UNDERSTAND ITS TERMS AND AGREE TO BE BOUND BY ITS TERMS.