In connection to donating sperm as known or known dedicated donor, we would like to ask you to sign the following:

1. That you agree to the woman/couple who will receive sperm from you is being given a copy of the written donor evaluation, made on the basis of the questionnaire, a donor interview and relevant examinations.

2. That you have answered the questions honoestly, to the best of your knowledge, you were asked in the questionnaire and during the interview.

3. That you agree that one or more portions of sperm must be frozen.

4. That you donate sperm on a voluntary basis.

5. That you donate your sperm as a known donor or known dedicated donor.

6. That you agree that, in relation to Danish legislation, you are the legal father of the child if the woman you are donating to is single.

7. That you agree that you will not be the child's father if the woman you are donating to is married or in a marriage-like relationship with a man.

8. That you agree that if you donate to a lesbian couple, together with the couple you must decide who, together with the woman giving birth, will be the legal parent before the treatment starts (Familieretshuset blanket 9 is used here).

9. That you have informed your eventual partner/spouse about your donation.

10. That you are informed that you at any time can ask for unused sperm to be destroyed.

11. That you must consent to any use of your sperm (insemination, fresh IVF or treatment with fertilized eggs from the freezer).

12. That you agree that sensitive personal data such as CPR number, the quality of the submitted sperm samples and health information will be entered in the journal of the woman below.

13. That you are informed that you must notify the Clinic of Fertility, Rigshospitalet should information about genetic disease in you or your family later appear.

14. That you consent to the storage of data for traceability and transfer upon termination of the Clinic of Fertility, Rigshospitalet tissue center business in accordance with the Danish Tissue Act.

Donors name:                                                                               CPR:

Donors signature:                                                                        Dato:

I donate to: 

Womans name:                                                                             CPR:

Womans signature:                                                                      Dato:

Partner must, by his/her signature, accept the treatment and declare:

"should my wife/partner give birth to a child/children as a result of the above fertility treatment, I will in every respects consider the child/children as mine and consider it/them my legal heir(s)".

Partners name:                                                                               CPR:

Partners signature:                                                                        Dato:

This unless otherwise agreed in accordance with point 8.