Become a Surrogate | Hope Harbor Surrogacy

Become the Miracle a Family Has Been Waiting For

“Your kindness could change someone’s life forever. Complete the application below to see if you qualify for our surrogacy program.”

Minimum Requirements
Make sure you meet these before applying
✅
Age 25–35
✅
At least one healthy pregnancy and delivery
✅
Currently raising at least one child
✅
Non-smoker
✅
Healthy BMI (18.5–29.9)
✅
No illegal drug use
✅
Willing to complete medical and psychological screening

Step 1 of 12

Step 1 of 12

Personal Information

Let’s start with your basic information.

First Name *

Last Name *

Date of Birth *

Age *

Email Address *

Mobile Number *

WhatsApp Number

Address *

City *

State/Province *

Country *

ZIP/Postal Code *

Upload Recent Photo *
Head-and-shoulders photo, clear face (JPG, PNG, HEIC – Max 10 MB)

📸

Click to upload or drag and drop

JPG, PNG, HEIC up to 10 MB

Upload Government ID *
Passport, Driver’s License, or National ID

🪪

Click to upload or drag and drop

PDF or Image file

Step 2 of 12

Family Information

Tell us about your household and current situation.

Marital Status *

Occupation *

Highest Education Level *

Are you currently employed? *

Yes

No
Do you own or rent your home? *

Own

Rent

Other
Do you have reliable transportation? *

Yes

No
Who lives in your home? (e.g., spouse, children)

Step 3 of 12

Surrogacy Experience

Have you been a surrogate before?

Is this your first time applying as a surrogate? *

Yes

No
How many surrogate journeys have you completed? *

How many successful births? *

Agency you worked with (optional)

Number of pregnancies *

Number of live births *

Number of miscarriages

Number of C-sections

Last delivery date *

Any pregnancy complications? (describe if yes)

Step 4 of 12

Medical Information

Your health is important to us and the families we serve.

Height (cm) *

Weight (kg) *

Blood Type *

Current Medications (if any)

Allergies (if any)

Previous surgeries (if any)

Chronic illnesses or conditions (if any)

Mental health history (if any)

Do you currently have health insurance? *

Yes

No

Step 5 of 12

Your Lifestyle

Help us understand your lifestyle habits.

Do you smoke? *

Yes

No
Do you vape? *

Yes

No
Do you drink alcohol? *

Yes (occasionally)

Frequently

No
Do you use recreational drugs? *

Yes

No
Do you exercise regularly? *

Yes

No
Do you follow a special diet? (if yes, describe)

Step 6 of 12

Your Children

Tell us about your family.

How many children do you have? *

Children’s ages (separate by comma) *

Are your children living with you? *

Yes

No
Who helps care for your children? (e.g., spouse, family, daycare)

Step 7 of 12

Your Motivation

Help us understand your journey.

Why do you want to become a surrogate? *

Have you discussed this with your spouse or partner? *

How do your family members feel about your decision?

What does helping another family mean to you?

Step 8 of 12

Availability & Travel

Let us know about your availability.

When can you start? *

Immediately

Within 3 months

Within 6 months

Later
Can you travel? *

Yes

No
Do you have a valid passport? *

Yes

No
Can you attend regular appointments? *

Yes

No
Preferred communication method *

Step 9 of 12

Emergency Contact

In case we need to reach someone.

Emergency Contact Name *

Relationship *

Phone Number *

Email *

Step 10 of 12

References

Please provide two professional or personal references.

Reference #1

Name *

Relationship *

Phone Number *

Email *

Reference #2

Name *

Relationship *

Phone Number *

Email *

Step 11 of 12

Identity Verification

To ensure authenticity, we may request additional verification.

Have you used social media in the last 12 months? *

Yes

No
Optional: Instagram/Facebook profile (for verification only)

Upload a Selfie Taken Today (Optional)
Recent selfie for verification purposes

🤳

Click to upload or drag and drop

JPG or PNG

Upload Full-Body Recent Photo (Optional)
Recent full-body photo

📷

Click to upload or drag and drop

JPG or PNG

Step 12 of 12

Final Declaration

Please confirm your agreement to our terms.

Consent & Agreement *

I confirm that all information provided is accurate and truthful.

I understand that submitting this application does not guarantee acceptance into the program.

I consent to background, medical, and psychological screening if selected to continue.

I agree to the Privacy Policy and Terms & Conditions.

🎉
Thank You for Applying!
Your application has been received successfully. We’re excited to learn more about your journey!
Application ID
SHS-2026-000001
A Family Coordinator will review your application within 24–48 hours and reach out to you using your preferred contact method.
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