Apply Today To Become A Surrogate!

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Surrogate Mother Application Form

Please use the following form to apply to be a surrogate mother.

CONFIDENTIAL
  • Instructions:

    Within this online form you will be required to provide the following accompanying documents :

    - Pictures of yourself/partner/family.
    - Picture of government issued identification (such as a driver's licence/passport/health card).
    - Please send additional pictures (preferably 5-10) to sally@surrogacy.ca

    Surrogacy in Canada Online will keep all of the information on your application confidential except for purposes related to surrogacy services. Therefore, this information will be shared with prospective parents, physicians, lawyers, and mental health providers as needed.

    ***This application may take about 10 minutes to complete.***

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    Selective reduction is the practice of reducing the number of fetuses in a multiple pregnancy. This procedure is usually performed in the first trimester of a high risk pregnancy (and rare in surrogacy).
  • Supporting Documents

    Please provide Surrogacy in Canada Online with the following documents. (If having trouble uploading, you can email pictures directly to sally@surrogacy.ca)
  • 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. All of the information I have provided to Surrogacy in Canada Online in this application is complete, true and accurate to the best of my knowledge.

    2. Surrogacy in Canada Online did not coerce, induce or unduly influence my/our decision to apply to be a surrogate mother.

    3. Surrogacy in Canada Online does not represent me/us or will be providing us with legal or medical counsel.

    4. Surrogacy in Canada Online is not party to any agreement that I/we may enter into with intended parents.

    5. Surrogacy in Canada Online 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 Surrogacy in Canada Online, 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. Surrogacy in Canada Online will be providing my/our application/photos and the information I/we provided to prospective intended parents electronically and/or in print. This information will also be provided to the IVF clinic, lawyers and social worker/psychologist involved with any resulting match. I/We acknowledge that Surrogacy in Canada Online provides my/our information to prospective intended parents, IVF clinic, lawyers and social worker/psychologist and hereby consent to my/our application and related information being provided electronically and/or in print. I/We acknowledge that Surrogacy in Canada Online can remove/delete all my/our information upon request.

    7. I/We hereby release and discharge Surrogacy in Canada Online, 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.

    9. I/We agree to inform Surrogacy in Canada Online if, at any time, I/we no longer wish to and/or am unable to participate, as well as if I become involved with intended parents for surrogacy through any other means and/or organization.

    10. I/We understand that in order to gain access to the members section of Surrogacy in Canada Online, my/our contact information is required and that both my email and the IP address will be recorded by Surrogacy in Canada Online.

    11. I/We hereby certify that I am requesting access to the members section solely for the purpose of looking at prospective intended parents. All other purposes are unauthorized. I further acknowledge that to protect the privacy of all participants in Surrogacy in Canada Online program, both my email and the IP address will be used to pursue legal action against me/us for attempting to gain access to this program for any other purposes.

    12. I/We agree to maintain a level of respect and courtesy to all Surrogacy in Canada Online staff and members. Failure to do so will result in my/our immediate removal as members of Surrogacy in Canada Online.

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