Note: The last three chapters are plain text versions of a form I created for this verse. I suggest reading this fic on archiveofourown to view the form correctly. My penname there is also slythatheart.
Form Approved Through 06/30/2020
OMB No. 1204-0003
DoWS Agreement No.
8046
DEPARTMENT OF WERE SERVICES
Same-Sex Family Connection Agreement
Page 1 of 2
CANDIDATE COUPLE A
SECTION 1 – REGISTRATION DETAILS
Registration No. OH-M1483
Registration Date: 04/14/2018
Case-Worker: Alexandra King [OHB3-72]
SECTION 2 – CANDIDATE DETAILS
WERE Candidate No. OH-M1483W
Name: Sebastian Karofsky-Smythe
Gender: [ X ] Male [ ] Female
Species: Jaguar (Panthera Onca)
HUMAN Candidate No. OH-M1483H
Name: David Karofsky-Smythe
Gender: [ X ] Male [ ] Female
SECTION 3 – AGREEMENT REQUIREMENTS
SECTION 3A – GENERAL NEEDS
Total Intended Children: 2-3
Acceptable Fertilization Method(s): [ X ] Insemination [ ] Natural
Additional children negotiable: [ X ] Yes [ ] No
/
SECTION 3B – DONOR/SURROGATE ADDITIONAL NEEDS
Requirements Met: [ X ] Yes [ ] No
Details: Aged from 21 – 30, no history of genetic ill-health, intelligent
SECTION 4 – DONOR/SURROGATE DETAILS
SECTION 4A – DONOR DETAILS
Candidate No. OH-F1262H
Name: Santana Lopez
Role: Egg donor and surrogate mother
/
SECTION 4B – INTENT TO CONCEDE CUSTODY
I, the undersigned, intend to act in the role stipulated in Section 4A for the listed candidates and concede all parental rights and responsibilities upon birth.
Signed: Santana Lopez
Date: 07/10/2018
SECTION 5 – INTENT TO ACCEPT CUSTODY
We, the undersigned, intend to formally accept all parental rights, responsibilities and custody for any child produced as a direct result of this agreement by the donor/surrogate listed in Section 4 and the WERE Candidate as listed in Section 2.
Signed: Sebastian Karofsky-Smythe
Role: Natural father
Date: 07/10/2018
Signed: D. Karofsky-Smythe
Role: Matebound Father
Date: 07/10/2018
CANDIDATE COUPLE B
SECTION 1 – REGISTRATION DETAILS
Registration No. OH-F1262
Registration Date: 02/02/2018
Case-Worker: Jennifer Adams [OHB5-24]
SECTION 2 – CANDIDATE DETAILS
WERECandidate No. OH-F1262W
Name: Brittany S. Pierce
Gender: [ ] Male [ X ] Female
Species: Trumpeter Swan (Cygnus Buccinator)
HUMAN Candidate No. OH-F1262H
Name: Santana Lopez
Gender: [ ] Male [ X ] Female
SECTION 3 – AGREEMENT REQUIREMENTS
SECTION 3A – GENERAL NEEDS
Total Intended Children: 2
Acceptable Fertilization Method(s): [ X ] Insemination [ X ] Natural
Additional children negotiable: [ X ] Yes [ ] No
/
SECTION 3B – DONOR/SURROGATE ADDITIONAL NEEDS
Requirements Met: [ X ] Yes [ ] No
Details: Age range 23 – 27, healthy background
SECTION 4 – DONOR/SURROGATE DETAILS
SECTION 4A – DONOR DETAILS
Candidate No. OH-M1483H
Name: David Karofsky-Smythe
Role: Sperm donor
/
SECTION 4B – INTENT TO CONCEDE CUSTODY
I, the undersigned, intend to act in the role stipulated in Section 4A for the listed candidates and concede all parental rights and responsibilities upon birth.
Signed: D. Karofsky-Smythe
Date: 07/10/2018
SECTION 5 – INTENT TO ACCEPT CUSTODY
We, the undersigned, intend to formally accept all parental rights, responsibilities and custody for any child produced as a direct result of this agreement by the donor/surrogate listed in Section 4 and the WERE Candidate as listed in Section 2.
Signed: Brittany S. Pierce
Role: Natural mother
Date: 07/10/2018
Signed: Santana Lopez
Role: Matebound Mother
Date: 07/10/2018
