IParent Data Acquisition Form (BC) v1.0 / 2026-01-05

Thank you for sharing your story. The information you provide will help potential surrogates learn about you, your family, and your hopes for this journey.

Date of Collection:

Intended Parent #1

First Name

Last Name

Preferred Name for Profile

Address

Address Line 1

Address Line 2

City

State / Province / Territory

Zip / Postal Code

Country

Phone/Mobile

Date of Birth

Citizenship

Residency

Occupation

Intended Parent #2

First Name

Last Name

Preferred Name for Profile

Address

Address Line 1

Address Line 2

City

State / Province / Territory

Zip / Postal Code

Country

Date of Birth

Citizenship

Residency

Phone/Mobile

Section 2 — About Your Family

Tell us about yourselves

Tell us about your personalities?

What do you enjoy doing in your free time?

Section 3 — Your Journey to Surrogacy

What led you to pursue surrogacy?

What does becoming a parent mean to you?

What kind of relationship would you like with your surrogate during the journey?

Section 4 — Your Home & Lifestyle

Tell us about your home and community

Do you have pets?

Yes

Do you have other children?

Yes

Section 5 — Support System

Who is part of your support network?

How does your family feel about your surrogacy journey?

Section 6 — Message to Your Future Surrogate

This is the most important part of the profile.

Encourage intended parents to:

- express gratitude

- share their hopes

- acknowledge the generosity of surrogates

Write a message directly to a potential surrogate.

Section 7 — Surrogacy Preferences

Preferred level of communication

Will you attend medical appointments when possible?

Preferred delivery location

Section 8 — Photos

Profiles with photos and videos receive significantly higher surrogate interest.

Please upload:

photos of Intended Parent(s) together
casual lifestyle photos
a video of a memorable event or special occasion (birthday, Christmas, etc)
a sincere, heartfelt video message to surrogates
Optional family photos
Optional home environment photo

File Upload

Choose File

Section 9 — Optional Profile Details

Favorite activities:

Favorite vacation destination:

Favorite food:

Something unique about your family:

A fun fact about you:

Bonus question

This question often creates the most powerful emotional connection in profiles.

What would you like your future child to know about the surrogate who helped bring them into the world?

Section 10 — Profile Privacy Options

How would you like your profile displayed?

Section 11 — Marketing Consent

I consent to my submitted profile being shared with potential surrogates and used in promotional materials as outlined in the Intended Parent Marketing Consent Form.

Section 12 — Final Confirmation

By submitting this form, I confirm that the information provided is accurate to the best of my knowledge.

Signature of Intended Parent #1:

Sign Here

Date of Signing:

Signature of Intended Parent #2 (if applicable):

Sign Here

Date of Signing:

Signature of Witness:

Sign Here

Witness First Name

Witness Last Name

Date of Signing:

I have read and agree to the Terms and Conditions and Privacy Policy