A – EC 3065, Brits
Generate PDFAvailability status: | Available now in Pretoria and Johannesburg (travel costs), coastal areas - travel costs |
Race: | White |
Age: | 21 |
Hair colour: | Blonde |
Eye colour: | Blue/Green |
Has children: | No |
Proven donor | Yes |
Post matric studies: | No |
Other physical information: | 1.79m., 65kg., fair skin complexion, long and slim build, breast cup 36C, size 8 shoe, freckles on my shoulders, one dimple |
Face shape: | Oblong |
Other personal information: | South African, Christian. Candidate aspires to be a veterinary assistant. She has completed a bonsmara course - cattle. She is a kind loving person and my interest is to help other people have children. Non-smoker. Reason for donating:I really want to help the people who can’t have children. |
Reproduction history: | No children and good quality eggs in previous donation resulting in a pregnancy |
What are your views on religion and spirituality, and practiced religion? | I'm a Christian |
Category: Active Donor
Additional donor information
Initial information
In which town and province do you live? | Brits, North West |
Nationality | South African |
Where were you born? | Pretoria |
What language(s) do you speak? | Afrikaans and English |
Year of birth | 2001 |
Age | 21 |
Star sign | Gemini |
Blood group (if known) | Unknown |
Why do you want to be an egg donor and if you had a message for your recipient what would it be? | I really want to help the people who can’t have children. |
How do you best describe yourself? | Loving and kind |
Relationship status | Serious relationship |
Physical profile
Race | White/ Caucasian |
Skin complexion | Fair |
Face shape | oblong |
Nose shape defined by Wikipedia | Roman - Convex undulating nose |
Eye shape | Round Almond |
Height in metres | |
Weight in kilograms | |
What is your usual or ideal weight? | 65kg. |
Build and body shape | Long and slim |
Which body part is most sensitive to weight gain or loss? | Hips |
Eye colour | Blue |
Natural hair colour | Blonde |
Hair colour as a child | Blonde |
Hair type | Straight |
Hair texture | medium |
Description of hands and fingers | Thin and long |
Any other defining traits such as breast cup, size shoe size, freckles, dimples, etc | Breast cup 36C, size 8 shoe, freckles on my shoulders, one dimple |
Are you left handed or right handed? | Right handed |
With celebrity do you most resemble - physically? | Juanita du Plessis |
Siblings physical traits - hair and eye colour, height, weight and build | 1.73m., 86kg., brown hair, blue/green eyes |
Reproductive information
Are you a virgin? | No |
Ever miscarried? | No |
No. and ages of children (if applicable) | None |
Fertility issues | None |
Health of egg donor
Are you a twin? | No |
Are you adopted? | No |
Current health status lifestyle and/ or current diseases | I'm healthy and don't have any diseases. |
Smoker | Ex-smoker |
Alcohol consumption per week. | 0 |
Do you wear glasses? | Never |
How would you rate your sight? | Fair |
Any skin disorders, albinism, ectodermal dysplasia, eczema, acne, etc | Acne |
Have you suffered from/ currently have any health concerns/ diseases including but not limited to diabetes, cholesterol, blood pressure, thyroid, haemophilia, blood clotting, paralysis, porphyria? | No |
Have you had any cancer? | No |
Have you had any heart problems? | No |
Please indicate if you have any allergies | Dust and pollen |
Any mental or psychological diseases/ learning disorders including but not limited to genetic depression, bi polar, psychiatric illness etc. Please elaborate and indicate if genetic. | No |
Any physical handicaps or deformaties? If yes, please state. | No |
Do you have any genetic diseases or are a carrier of any genetic concerns including but not limited to thalassemia, cystic fibrosis and sickle cell? | No |
History of asthma | No |
Indicate any medication you are taking and reason for it. | None |
Have you ever been addicted to any substances? | No |
Have you partaken in any recreational drugs had tattoos or piercings in the last six months? Please explain. | No |
Details of any operations? | Nothing |
Are there any health issues of which you are aware that may be of concern for you to become an egg donor? If yes, please state. | No |
Any specific diet such as vegan, vegetarian, health conscious, low fat, etc. | No |
How often do you excercise? | When I Get A Chance |
In which exercises or sports do you partake now? | Nothing |
Have you excelled in any sports? | No |
What sports did you play at school? | Swimming, horse back riding and dancing |
Professional and academic information
Occupation | Administration |
What is your ideal career/ occupation? | Veterinary assistant |
What are you doing to get to your desired profession in life? | To study hard |
Do you have a matric and university exemption? | Only Matric |
Subjects and grades or marks at school | Natural Sciences, Agricultural Development, and CAT |
What is the name of any course / degree completed? | Bonsmara course |
Planned studies | Yes |
In what aspects do you have a keen interest? | Animals |
What type of books do you like to read? | |
Would you prefer to read the book or watch the movie? | Watch the Movie |
Do you know if your IQ was ever tested and the score please? |
Behavioural traits
What is most important in life to you? | My family |
If you had unlimited resources and could save one thing on earth what would it be? | My animals |
What are your views on religion and spirituality, and practiced religion? | I'm a Christian |
Childhood religion? | Christianity |
Any specific achievements or aspects of recognition in your family | No |
Interests and hobbies | To be successful |
What is your preferred holiday? | |
If you were offered an all-inclusive holiday, what would it be? | |
Which interesting places have you visited? | Mozambique |
What are your feelings on animal welfare? | I love animals and people should watch after their animals. |
Strength and weaknesses | Strengths - efficient |
What do others generally think of you? | Nice |
Favourite flower | Sunflower |
What is your favourite meal? | Chicken |
What is your favourite movie? | 5 Feet Apart |
What is your favourite book? | |
Who is your favourite actor? | Johnny Depp |
Who is your favourite actress? | Sandra Bullock |
What is your favourite colour? | Yellow |
What is your favourite colour lipstick? | natural color |
What is your favourite perfume? | Alien |
Who is your favourite person? | My parents |
Are you more introverted or extroverted? | Introverted |
Would you prefer to go out with friends or stay in with a loved one or book? | Stay in with a loved one or book |
Are you musical or played any musical instruments? | No |
Are you more cultural or more adventurous? | More Adventurous |
Do you prefer indoors or outdoors? | Outdoors |
Which weather do you prefer? | |
Are you more creative or analytical? |
Family information of genetic parents
Nationality for mother and father | Both South African |
Country of origin and ancestry for mother and father | Both South Africa |
Language spoken for mother and father | Both Afrikaans |
Professions for mother and father | Mom -housewife, dad - boilermaker supervisor |
Achievements on an academic level for mother and father | |
Race for mother and father | Both white |
Natural hair colour for mother and father | Mom - blonde, dad - black |
Eye colour for mother and father | Mom - blue, dad - green |
Height for mother and father | Mom - average length, dad - tall |
Mother and father build | |
Any specific defining traits for both parents | |
Are your parents still alive? | Yes to Both |
If deceased, cause of death | Not applicable |
Age (if living, or age deceased) | Mom - 43, dad - 50 |
Health status | Both healthy |
Please indicate if any twins in your family and the relationship to you | My grandmother had twins but she had a miscarriage |
Please list any family members who have had cancer including aunts or uncles and on which family side | None |
Any fertility problems in your family | No |
In your family, has anyone suffered from/ currently have any health concerns/ diseases including but not limited to diabetes, cholesterol, blood pressure, thyroid, haemophilia, blood clotting, paralysis, porphyria, heart problems? | My dad has blood pressure |
In your family, does anyone have any genetic diseases or are a carrier of any genetic concerns including but not limited to thalassemia, cystic fibrosis, sickle cell, tay sachs? | No |
Any mental or psychological disease or learning disability or learning disorders including genetic depression, bi polar, psychiatric illness in siblings or family? If yes, please state | No |
Any physical deformaties or handicaps? If yes, please state | No |
History of asthma | -1 |
Any skin disorders, albinism, ectodermal dyslasia or other in your family – please explain | No |
Any other comments regaring any health aspects in your family | No |
Alcoholism / substance abuse | No To Both |
Grandmothers still alive? | Only MGM |
If deceased, state cause of death | Unknown |
Current age or age of death | 65 |
Grandfathers still alive? | No to Both |
If deceased, state cause of death | MGF - car accident, PGF - heart attack |
Current age or age at time of death | |
Grandfathers' eye colour (maternal and paternal) | Brown |
Grandmothers' eye colour (maternal and paternal) | MGM - green/ hazel |
Grandfathers' hair colour (maternal and paternal) | Black |
Grandmothers' hair colour (maternal and paternal) | Brown |
Health of grandmothers (maternal and paternal) | Healthy |
Health of grandfathers (maternal and paternal) | |
Please specify if the race of your grandparents is different to yours. If mixed race, please specify race for maternal and patermal grandparents | All White |
Any genetic health or psychological concerns worth noting regarding your grandparents | No |
Any notes/ comments re family of family health aspects - genetic ito psychological, physical, deformaties, diseases, concerns | No |
Egg donation stipulations
Please indicate if you have any donation conditions or criteria such as persons to whom you prefer not to donate | I'd like to donate to white christians. |
Preferred town to donate | Pretoria |
Towns available in which to donate - travel costs will be covered | Pretoria |
Confirmation
I have only made myself available as an egg donor with baby2mom. | Yes |
Please advise any specific donation criteria other than those mentioned | I don't have any other donation criterias. |
All information provided is correct and pictures are all of me. I agree to keep baby2mom updated with the donor programe (screening, blood tests, scans, egg retrieval. I will keep baby2mom updated wrt my availability and wrt egg donation pregnancies achieved. I consent to participate in the baby2mom egg donor program and participate as required and understand the concept of anonymous egg donation and claim no further rights over any child(ren) conceived of egg donation. I agree that I will be prescribed medication to potentially synchronise my menstrual cycle with that of the recipients and will be given hormones in a controlled environment by professional fertility specialists to stimulate donor egg developement. I agree to find more information pertaining to egg donation on the baby2mom egg donor site or ask if I have any further questions about being an egg donor. I agree to participate as required as people often travel from international destinations to participate in a South African egg donation program and have incurred considerable financial and emotional costs | Yes |