S – MP 4626, Brits
Generate PDF| Availability status: | Availability to donate in Pretoria and Johannesburg |
| Race: | White |
| Age: | 20 |
| Hair colour: | Brown |
| Eye colour: | Brown |
| Has children: | No |
| Proven donor | No |
| Post matric studies: | Yes |
| Other physical information: | 1.64m., 64kg., hourglass |
| Face shape: | Round |
| Other personal information: | South African nationality, O- blood group. Candidate is an outdoor lover. She enjoys nature for what it had to offer. She is a fun and loving friend and loves to interact with people. |
| Reproduction history: | No children and no donations as yet. |
| What are your views on religion and spirituality, and practiced religion? | I’m Christian but I respect other religions |
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? | Brits |
| What language(s) do you speak? | Afrikaans |
| Year of birth | 2003 |
| Age | 20 |
| Star sign | Scorpio |
| Blood group (if known) | O- |
| Why do you want to be an egg donor and if you had a message for your recipient what would it be? | I’d like to be a egg donor for the person that wishes to become a mom one day. Everyone has a dream and I think for most women that dream is to become a mom, and have a family of your own. So I’d like to be the person to make a change and let that dream come true |
| How do you best describe yourself? | I’m passionate, loyal, honest and my colleagues consider me hardworking. I’m also motivated and loves to learn new things |
| Relationship status | Single |
Physical profile
| Race | White/ Caucasian |
| Skin complexion | Fair |
| Face shape | round |
| Nose shape defined by Wikipedia | Greek - perfect straight nose |
| Eye shape | Round Almond |
| Height in metres | 1.64 |
| Weight in kilograms | 64 |
| What is your usual or ideal weight? | 61 |
| Build and body shape | Hourglass, skinny |
| Which body part is most sensitive to weight gain or loss? | Waist |
| Eye colour | Brown |
| Natural hair colour | Brown |
| Hair colour as a child | Light brown |
| Hair type | Curly |
| Hair texture | Thick |
| Description of hands and fingers | I have small hands with straight medium length fingers, and small nails |
| Any other defining traits such as breast cup, size shoe size, freckles, dimples, etc | Breats cup 34C, size 6 shoe. |
| Are you left handed or right handed? | Right handed |
| With celebrity do you most resemble - physically? | Selena Gomez |
| Siblings physical traits - hair and eye colour, height, weight and build | 1.56m., 59kg., brown hair and eyes |
Reproductive information
| Are you a virgin? | No |
| Ever miscarried? | No |
| No. and ages of children (if applicable) | None |
| Fertility issues | None of which I am aware. |
Health of egg donor
| Are you a twin? | No |
| Are you adopted? | No |
| Current health status lifestyle and/ or current diseases | Healthy |
| Smoker | Ex-smoker |
| Alcohol consumption per week. | None |
| Do you wear glasses? | Never |
| How would you rate your sight? | Good |
| Any skin disorders, albinism, ectodermal dysplasia, eczema, acne, etc | No |
| 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 | None |
| 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? | Wisdom teeth |
| 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? | A few times a week |
| In which exercises or sports do you partake now? | Gym |
| Have you excelled in any sports? | Hockey |
| What sports did you play at school? | Hockey, netball |
Professional and academic information
| Occupation | Au pair |
| What is your ideal career/ occupation? | Lawyer |
| What are you doing to get to your desired profession in life? | Graduate |
| Do you have a matric and university exemption? | Matric and Exemption |
| Subjects and grades or marks at school | Afrikaans 52%, English 56%, Maths Literacy 61%, Life Orientation 47%, Computer Science 41%, Consumer Studies 49%, Tourism 63% |
| What is the name of any course / degree completed? | Entertainment |
| Planned studies | Law |
| In what aspects do you have a keen interest? | Photography |
| What type of books do you like to read? | Non-fiction |
| 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? | No |
Behavioural traits
| What is most important in life to you? | Friends and family |
| If you had unlimited resources and could save one thing on earth what would it be? | Homeless |
| What are your views on religion and spirituality, and practiced religion? | I’m Christian but I respect other religions |
| Childhood religion? | Christian |
| Any specific achievements or aspects of recognition in your family | |
| Interests and hobbies | Sport, cultures, travel, music, outdoor |
| What is your preferred holiday? | Beach, Bush |
| If you were offered an all-inclusive holiday, what would it be? | |
| Which interesting places have you visited? | USA |
| What are your feelings on animal welfare? | I am an animal lover and have 2 dogs of my own |
| Strength and weaknesses | Strength - conflict, weakness - being lonely |
| What do others generally think of you? | I’m out going and silly |
| Favourite flower | Sunglower |
| What is your favourite meal? | Braai vleis |
| What is your favourite movie? | Kissing booth |
| What is your favourite book? | |
| Who is your favourite actor? | Jason Statham |
| Who is your favourite actress? | Jennifer Aniston |
| What is your favourite colour? | Brown |
| What is your favourite colour lipstick? | Pink |
| What is your favourite perfume? | |
| Who is your favourite person? | My friends |
| Are you more introverted or extroverted? | Extroverted |
| Would you prefer to go out with friends or stay in with a loved one or book? | Depends on the situation |
| Are you musical or played any musical instruments? | Piano |
| Are you more cultural or more adventurous? | Bit of Both - depending on Situation |
| Do you prefer indoors or outdoors? | Outdoors |
| Which weather do you prefer? | Cold, Rain |
| Are you more creative or analytical? | Creative |
Family information of genetic parents
| Nationality for mother and father | Both South African |
| Country of origin and ancestry for mother and father | Germany |
| Language spoken for mother and father | Afrikaans |
| Professions for mother and father | Mom - general manager at municipal department, Dad- fire chief |
| Achievements on an academic level for mother and father | Degree holders |
| Race for mother and father | Both White |
| Natural hair colour for mother and father | Mom - brown, dad- black |
| Eye colour for mother and father | Green and brown |
| Height for mother and father | Mom - 1.57m., dad - 1.83m. |
| Mother and father build | Round, hourglass |
| Any specific defining traits for both parents | None |
| Are your parents still alive? | Yes to Both |
| If deceased, cause of death | Not applicable |
| Age (if living, or age deceased) | 50 and 52 |
| Health status | |
| Please indicate if any twins in your family and the relationship to you | |
| Please list any family members who have had cancer including aunts or uncles and on which family side | Healthy |
| 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? | No |
| 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 | No To Both |
| 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? | Yes to Both |
| If deceased, state cause of death | Not applicable |
| Current age or age of death | 73 and 78 |
| Grandfathers still alive? | No to Both |
| If deceased, state cause of death | Heart attack and cancer |
| Current age or age at time of death | 58 and 64 |
| Grandfathers' eye colour (maternal and paternal) | Both brown |
| Grandmothers' eye colour (maternal and paternal) | Green and blue |
| Grandfathers' hair colour (maternal and paternal) | Brown and black |
| Grandmothers' hair colour (maternal and paternal) | Brown and black |
| Health of grandmothers (maternal and paternal) | Healthy |
| Health of grandfathers (maternal and paternal) | Deceased |
| 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 | None |
| Any notes/ comments re family of family health aspects - genetic ito psychological, physical, deformaties, diseases, concerns | None |
Egg donation stipulations
| Please indicate if you have any donation conditions or criteria such as persons to whom you prefer not to donate | N/A |
| 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 | None |
| 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 |
