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AlphaCord - Preserving Newborn Stem Cells

Lifesource Client Registration

Lifesource clients can use this web page to register newborn stem cell storage with AlphaCord. Please review and agree to our Client Service Agreement and provide contact & payment information.
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Client Service Agreement & Annual Storage Terms:

Client Service Agreement

Please read the contract below. If you agree, click on the “I Agree” button below to register your account with AlphaCord.

CLIENT SERVICE AGREEMENT:
CORD BLOOD AND CORD TISSUE STEM CELL COLLECTION, PROCESSING & STORAGE
1. Recitals. Each undersigned, Legal Guardian, on their behalf and the behalf of their child’s ("Child") cryopreserved umbilical cord blood, request under this Agreement, that Alpha Cord, LLC ("Alpha Cord" or “We” or “Our” or “Us”) arrange for the transport and storage of their human cells, Umbilical Cord Blood and/or Placental Cord Blood ( collectively "Cord Blood") which was previously collected and processed by Lifesource Cryobank, LLC (“Lifesource”) prior to the execution of this Agreement. Each of the undersigned understands and acknowledges the following, legally binding terms of this Agreement, between Alpha Cord and each  undersigned, Legal Guardian or Parent (hereinafter, the "Client” or “You" or “Your”). For those who have stored their adult cells, the term Legal Guardian, Parent or Child(s) shall refer to the adult who has stored his/her own cells.

2.  Purpose.  Cord Blood is cryopreserved for possible therapeutic use in the event that the Child's stem cells may be needed to treat the Child or other members of the Child's immediate or extended family.  You understand and acknowledge that stem cells from alternative sources, such as bone marrow, are currently used to treat various life-threatening conditions such as leukemia, other cancers and blood disorders. You understand that Your Child’s Cord Blood is being stored for the possible use by the Child or other family members who may need a stem cell transplant in the future.  You understand that cryopreservation of cord blood is a relatively new procedure, and, while laboratory tests and studies thus far have indicated it is a successful method of preservation of cord blood, no long-term assurances can be made about the effectiveness of preservation.  You also acknowledge that successfully collecting, storing and transplanting stem cells from Cord Blood does not guarantee successful treatment (s), and that stem cells used in a clinical setting require the prescription of a licensed physician. You also understand that the physician or regulations may require supplemental testing if a transplant occurs. 

3.  Ownership of Cord Blood. You agree to be the custodian of the Cord Blood until the Child reaches eighteen (18) years of age.  When the Child becomes eighteen (18) he or she will become the custodian of the Cord Blood. This section 3 does not apply to adults who have stored their own cells.

4.  Retrieval of Sample for Use.  In the event the Cord Blood is requested by a licensed physician for treatment, You shall provide written notification to Us at least 14 days prior to the requested delivery date.  You agree to complete all forms issued by Us or Your healthcare providers prior to and subsequent to the retrieval of Your sample. The notice shall include the name and address of the physician and hospital receiving the Cord Blood. You shall be responsible for any and all preparation, shipping or transfer fees or costs incurred by Us. In addition, all fees due to Us must be paid in full prior to a transfer of the Cord Blood.

5.  Services and Fees. The services provided by Us include transportation of Your Cord Blood unit to our facility and cryogenic storage of Your child’s previously processed and cryo-preserved Cord Blood at Our facility. We reserve the right to transfer the stored Cord Blood to another licensed storage facility during the term of this Agreement with or without prior written notice to You at Our expense. You agree:
a) If you have completely paid your processing fees or payment plan with Lifesource and previously elected to make annual storage payments, You will pay Us a $125 Annual Storage Fee each year the unit is in cryogenic storage. If you have pre-paid for multiple years of storage, You will not owe any Storage Fees until the expiration of the pre-paid term You already paid to Lifesource. 

b) If You have not completed paying Your processing fees or have not satisfied Your payment plan, you agree to complete these payments by paying Us the remaining amounts You had due with Lifesource. If You elected to make annual storage payments, those $125 payments will be due and paid to Us each year Your Unit is in cryogenic storage. If you have pre-paid for multiple years of storage, You will not owe any Storage Fees until the expiration of the pre-paid term You already paid to Lifesource. 

All Storage and Processing Fees will be charged to Your credit card on file with Us. Any Fees due will be billed at least 30 days prior to their due date, Annual Storage fees will be billed 30 days prior the annual birthday of Your Child. You agree to pay these fees by having a valid and current Visa, MasterCard, Discover card or Amex card on file with Us. Although it is not anticipated, We reserve the right to change Our storage fees to reflect changes in costs or market conditions.

6.  Term of Agreement.  This Agreement shall commence upon the date written next to the Alpha Cord Representative’s signature below. This Agreement shall remain in force for 1 year and shall renew automatically for additional one year periods unless either party notifies the other party in writing of their intent not to renew this Agreement. A non-renewal notice must be sent at least sixty (60) days prior to the anniversary date of this Agreement to Us via USPS Registered Mail or FedEx with documentation from FedEx evidencing signed receipt of non-renewal. 

7.  Termination of Agreement by Client.  If You choose to terminate this Agreement, the effective date of termination may only be the next anniversary of this Agreement. You must send Us notice at least sixty (60) days prior to the anniversary date of this Agreement via USPS Registered Mail or FedEx with documentation from FedEx evidencing signed receipt of non-renewal. All fees must be paid and current prior to You terminating this Agreement. You may elect to have Your Child’s Cord Blood transferred to a different facility.  Any expenses relating to the transfer of the Cord Blood as a result of the termination of this Agreement by anyone for any reason will be incurred by You. If You decide to terminate this Agreement, You will not be entitled to a refund of any amounts previously paid under this Agreement. If You do not make arrangements to transfer the Cord Blood to a licensed storage facility by the effective date of the termination, then all rights to, title to, and ownership of the Cord Blood will be relinquished to Us, in which event We may, at Our discretion, utilize, donate or dispose of the Cord Blood.

 8.  Termination of Agreement by Alpha Cord.  We may terminate this Agreement upon written notice to You if You fail to pay any fees within thirty (30) days of the due date.  Upon termination of this Agreement for nonpayment, all rights to, title to, and ownership of the Cord Blood will be relinquished to Us, in which event Alpha Cord may, at its discretion, utilize, donate or dispose of the Cord Blood.

9.  Assignment. Alpha Cord May assign this Agreement to any partnership, association, individual, corporation or other entity that provides similar services or intends, after such assignment to provide such services.  In order to provide the best possible services to You, Alpha Cord may delegate responsibilities hereunder to one or more subcontractors who perform similar services as part of their regular business activities.  This Agreement is not assignable by the Client without written notification to and written consent of Alpha Cord.

 10.  No Warranty or Guarantee; Limitation of Liability.  You acknowledge that neither Alpha Cord, Lifesource nor any of their respective officers, directors, shareholders, executives, employees, agents or consultants have ever made any representations, guarantees or warranties, express or implied, to You of any type or nature, including without limiting the generality of the foregoing, nor have there ever been any representations, warranties or guarantees with respect to (i) suitability of Cord Blood for future treatment of diseases; (ii) successful treatment of diseases by Cord Blood transplantation; (iii) any advantage(s) of Cord Blood transplantation over other treatments using stem cells; and (iv) the merchantability or fitness for a particular purpose or use of any product or service hereunder.  Client agrees that any claim against Alpha Cord, its agents, independent contractors, consultants or their assignees, including any claim for loss, injury, damage or destruction directly caused by Alpha Cord's failure to exercise reasonable care in the transportation or storage of the Cord Blood, shall be limited to the total amount of fees paid by the Client to Alpha Cord under this Agreement.

11.  Client Consent and Understanding. I hereby consent to and understand the following:
I previously consented to have my healthcare provider collect the Cord Blood after the birth of my child. I understand that there are potential benefits to the collection of Cord Blood, including the procurement of stem cells to treat certain diseases, such as certain cancers and blood disorders.  However, I understand that treatments based on stem cells are not the best treatment for all diseases, and that stem cell treatment for any particular disease may not be effective. I understand that it is possible that better treatment alternatives may be developed in the future. 
I also understand that there are alternatives to obtaining stem cells from cord blood, such as from bone marrow, and that stem cells harvested from alternative sources have proven effective in treating the same diseases as stem cells harvested from cord blood. I understand that my child or my family may never need to use the cord blood. 
I understand that the cord blood and a sample of maternal blood may have undergone various tests prior to the cryogenic storage of the Cord Blood, including but not limited to, testing for stem cell concentration, nucleated cells, as well as bacteria, viruses and fungi, hepatitis and HIV and that these tests may indicate that the Cord Blood may only be stored in a fashion that is quarantined from other stored blood. This type of storage may increase the annual storage fees paid by You. I consent to giving Alpha Cord copies of these tests and any other healthcare information about the cord blood or its biological Mother and Father reasonably required now or in the future from Lifesource or other healthcare providers in order for the storage facility to maintain compliance with any current or future regulations, laws or industry standards. I understand that the Cord Blood will be stored at cryogenic temperatures pursuant to procedures normal for the industry.  I understand that it is not known at this time how long cord blood can safely and effectively be stored using this process. If I request to have the cord blood released for use, I consent to have and pay for any required testing performed on the cord blood or biological parents or recipient of the cord blood unit.
I understand and agree that Alpha Cord’s liability for any breach of its obligations or other acts or omissions in connection with the services described in this Agreement is limited to the total amount I have paid to Alpha Cord under the Agreement.  I hereby release Alpha Cord and its officers, directors, employees, agents, affiliates, successors, independent contractors and assigns from any and all other liability for any and all loss, harm, damage or claim of any kind arising out of or related in any way to Alpha Cord’s service.  I understand that by this release I am giving up any right I might otherwise have, now or in the future, to sue or otherwise seek money damages or other relief against Alpha cord for any reason relating to the Services, with the sole exception of seeking a return of any moneys paid under the Agreement.
12.  Arbitration.  This Agreement shall be governed by and construed in accordance with the laws of the State of Georgia, applicable to contracts made in Georgia, by persons domiciled in Atlanta, Georgia and without regard to its principles of conflicts of laws.  Any claim for monetary damages under this Agreement shall be submitted to arbitration with the American Arbitration Association in Atlanta, Georgia, and shall be finally and conclusively determined by the decision of a board of arbitration consisting of one (1) member.   Any decision made by the arbitrator shall be final, binding and conclusive on the parties to the dispute, and entitled to be enforced to the fullest extent permitted by law and entered in any court of competent jurisdiction. 

13.  Notices.  Any and all notices that may be given in connection with this Agreement shall be in writing. Any notice(s) shall be deemed to have been duly given on the date of service if served personally on the party to whom notice is to be given, or within 72 hours after mailing, if mailed to the party to whom notice is to be given, by first class mail, registered or certified, postage prepaid, or by a “Next Day Air” service with a signature from the notified party evidencing receipt and properly addressed to the party at the address set forth on the signature page of this Agreement, or any other address that the party has designated by written notice to the other party.  The Client agrees to promptly notify Alpha Cord in the event of a change in Client's current mailing address at any time during the term of this Agreement.

14.  Miscellaneous.  This Agreement, represents the entire Agreement between the parties concerning the subject matter hereof, and there are no understandings, agreements, or representations other than as set forth herein.  This Agreement is binding upon the parties, their heirs, spouses, executors, administrators, successors and assigns.  No modification, amendment or waiver of any provision of this Agreement, nor any consent to any departure by any party from the terms hereof, shall be effective unless the same be in writing and signed by all parties hereto.  This Agreement shall be governed by the laws of the State of Georgia. If any provision of this Agreement is held invalid, illegal or unenforceable, the validity, legality or enforceability of the remaining provisions shall in no way be affected or impaired thereby.  Alpha Cord shall not be liable for any delay or failure to perform per the terms of this Agreement caused by Acts of God or other causes beyond the parties’ control and without fault or negligence.  This Agreement may be executed in one or more counterparts, each of which shall be deemed an original, but all of which together shall constitute one and the same instrument.

I have read and understand the above agreements, consents, limitation of liability and releases, and know that that the services described above are totally voluntary and elective on my part, and that I can refuse the services for any reason.  I have discussed the services with my healthcare provider and other advisors, and I have signed this Agreement freely and voluntarily.  By signing this Agreement, I hereby acknowledge that I am giving up legal rights I might otherwise have had.

Annual Storage Terms

Storage Fee Amount per Year:   $125  (to be automatically billed each year on the first of the month of your child’s birth to your credit/debit card on file). If you have pre-paid for 18 years of storage, you will not be charged this fee until your child’s18th birthday.

I authorize Alpha Cord, LLC to charge my card on file $125 for each year of cryogenic storage of my child’s stem cells. This form is now attached to and part of my Client Service Agreement with Alpha Cord, LLC.

In accordance with Chapter 12: Title 10: Official Code of Georgia Annotated, "Georgia Electronic Records and Signatures Act"; By clicking the "I Agree" button, I hereby affix my signature, signifying my consent and fully binding me to this agreement.

     

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