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Gift of Hope IVF Grant Program
Eligibility Requirements
FAQ’s
Gift of Hope Grant Consents
Gift of Hope Grant Consent
Name
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First
Last
Date of Birth
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Application Consent
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I agree
I declare my application to be the full truth to the best of my knowledge. I have read through the application instructions, eligibility requirements and frequently asked questions. I understand what is covered and not covered by the Gift of Hope Grant, and what services I may still need to pay for. I understand that selected applicant will be required to sign additional Medical Consent forms before infertility treatment cycle commences. I understand that I may be declined the award if I fail to meet prescreening needs for in vitro fertilization. In this case, another applicant may be selected to receive the grant.
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Rights Granted to Fertility Answers, LLC: The undersigned, an applicant to participate in GIFT of HOPE, an IVF grant program sponsored by Fertility Answers, LLC, grants and conveys to Fertility Answers, LLC the exclusive rights to develop and tell the applicant’s Story related to the applicant’s efforts to build a family, including but not limited to, information regarding the applicant and partner, the applicant’s immediate family members, the applicant’s medical and financial struggles related to pregnancy, pregnancy loss, infertility, fertility treatment, etc. (known in this agreement and release collectively as your “Story”). Applicant grants Fertility Answers, LLC, the exclusive right to share your Story in any and all media, now and hereafter developed, including but not limited to print media including books and magazines, and electronic media including all donors’ websites and social media platforms. Applicant agrees to be truthful with respect to all information provided to Fertility Answers, LLC, for inclusion in applicant’s Story. Applicant understands that providing incomplete, inaccurate or false information will cause significant harm to Fertility Answers, LLC, and agrees to indemnify and hold Fertility Answers, LLC and its respective donor organizations harmless against any claim, demand, or recovery brought against Fertility Answers, LLC as publisher of the applicant’s Story with respect to any information applicant provides that is not complete, correct, accurate and truthful. Upon selection for participation in GIFT of HOPE, applicant agrees to provide Fertility Answers, LLC and/or its agents with photographs of applicant, applicant’s partner and immediate family members and additional information to facilitate the telling of applicant’s Story as requested by Fertility Answers, LLC. Applicant agrees to allow Fertility Answers, LLC and/or its representatives or agents to attend, photograph, videotape and otherwise record for purposes of telling applicant’s Story, applicant’s medical appointments and other events related to applicant’s efforts to build a family. Applicant agrees and understands that she/he shall receive only the donated medical services included in the program as consideration for granting these rights to Fertility Answers, LLC and its respective donor organizations and shall receive no other consideration or compensation for granting these rights. Applicant hereby waives claim to any royalties, fees or other compensation Fertility Answers, LLC may receive related to publishing or other telling of applicant’s Story. THE UNDERSIGNED APPLICANT HAS READ AND UNDERSTANDS THE RIGHTS GRANTED TO FERTILITY ANSWERS, LLC, AND ITS RESPECTIVE DONOR ORGANIZATIONS IN THIS COPYRIGHT AND MEDIA RELEASE AND VOLUNTARILY GRANTS THE RIGHTS DETAILED IN THIS RELEASE TO FERTILITY ANSWERS, LLC, IN CONSIDERATION FOR THE OPPORTUNITY TO APPLY TO PARTICIPATE IN THE GIFT OF HOPE PROGRAM.
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