DISCLAIMER/RETAINER CONTRACT

This agreement is made this --- day of ------, 2007by and between Embryos Alive (hereinafter referred to as “EA”) and ----- (hereinafter referred to as “Client”).

_____ By submitting the release of information, completed application and $200.00 application fee and by submitting the completed disclaimer and the $100.00 disclaimer fee, I/we are stating that I/we want to be considered for a match. I/we understand that we will not be considered for a match until therelease of information, completed application and disclaimer forms are received and the associated fees are received.
_____ Once client/s accept a match; client/s agree to provide EA a notarized contract and remit the balance of EA fees in full. * (late fees accrue after 48 hours of $50.00 per day) Failure to pay balance of fees within 7 days may result in forfeit of embryo/s.
_____ Client/s homestudy or complete EA dossierwill be submitted to EA within (14) fourteen calendar days from the date client/s accept a match. Incomplete dossiers (see attached EA forms checklist) will be returned and an administrative hold fee of $50.00 per day up to (31) thirty one calendar days will accrue. After 31 calendar days the embryo/s which were matched are forfeited and any and all embryos will be put up for re-adoption. Any additional storage fees, fees for donor’s lab, Dr.’s office, storage facility or clinic services will also become due all fees are subject to an annual 18% interest fee or 1% monthly charge.
_____ Substantiated findings of child abuse or neglect, undisclosed felonies, and other substantial negative findings may result in the loss of the match. All fees are non-refundable and will not be applied to a future match.

_____ If client/s accidentally, inadvertently or in any way, receive any or all of the donor/s contact information and use this information to communicate with the donor/s directly without EA’s written agency approval prior to completion of EA dossier requirements, payment of EA matching fee, $800.00, and agency fee, $2,500.00, becomes due immediately, EA will continue to assist as needed with facilitation services, all fees are non-refundable and may not be used for any future match. Client agrees to pay any costs incurred due to their communication.

_____ In order to maintain statistics and for research purposes, and in some cases to facilitate agency liaison service to donors, client will provide E A or their agent any current contact information including valid e-mail address, phone number, and address within (5) five days of any changes until verification is made in writing by the Physician or lab that is storingthem that either no embryos remain in storage or any and all child/children are 18 years old (verified by written response from EA staff). Failure to provide current, valid contact information will result in a charge of all costs associated with locating adoptive parent/s and child/children, relinquishment of any remaining embryos and a penalty of $250.00 per day. EA may contact your references and employer for current contact information.

_____ Client/s agree that providing any false information or failing to provide requested information in the specified time period may result in the loss of adoptive match and fees including but not limited to administrative and legal expenses will be assessed to obtain and verify the information, and/or a penalty of up to $500.00.

_____ All questions concerning the construction, validity and interpretation of this Contract shall be governed by the laws of Hamilton county in the State of Ohio, and the performance of the obligations imposed by this Contract shall be governed by the laws of Hamilton county, Ohio applicable to Contracts made and to be wholly performed in such state. Adoptor/s are responsible for any and all court fees or arbitration costs.

_____ Client/s failure to complete dossier checklist within (31) thirty one calendar days from acceptance of match results in loss of fees and embryos. (no fees will be applied to a future match)

Please execute and notarize two (2) copies of this disclaimer and return one (1) copy to EA along with $100.00 Disclaimer/Retainer Contract fee.

CLIENT:
______

Husband (Print name) Wife (Print name)

State of ______State of ______

County of ______County of ______

Subscribed and sworn to before me,Subscribed and sworn to before me,
this ______day of ______, 2007. this ______day of ______, 2007.

______
Notary Public Notary Public

My commission expires:______My commission expires:______


7741 Pfeiffer RoadCincinnati, Ohio 45242
F 513-793-0052  Tf 888-242-5094  C 513-518-7006