You must be local or willing to travel to complete this form. This is for subs that will serve in a real time session. DO NOT APPLY IF YOU WANT ONLINE SESSIONS.
Name
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First Name
Last Name
Slave Name
*
Phone Number
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Area Code
Phone Number
Your Location
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City and State
Email
*
Fetlife and/or Kik Username
Sexual Orientation
*
Straight
Bi-sexual
Bi-Curious
Gay
I will be what you want, Mistress
Age
*
Height
*
Weight
*
Bondage Bondage
*
Hard Bondage
Soft Bondage
Chastity
Gags
Hoods
Plastic Wrap
Genital Bondage
Immobilization
Breast
Nipple Clamps
Other
Fetishes
*
Anal Pegging
Anal Beads
Butt Plugs
Fisting
Cock Worship(My Girl Cock)
Orgasm Denial
Swallowing Semen
Choking
Clothes Pin
Tens Unit
Spiting
Ice
Needles
Tickling
Hot Wax
CBT
Hair Pulling
Kicking
Breath Control
Uretha Sounds
Latex
Castration
Piercing
Fire Cupping
Vore
Adult Baby Play
Diaper Play
Age Play
Gigantism
Other
Humiliation
*
Furniture
Bathroom Use Control
Use Bathroom with Supervision
Boot/Legs/Feet Worship
Crawling
Cross Dressing/Feminization
Eye Contact Restriction
Collar & Leash
Golden Shower
Face Spitting
Other
Corporal Punishment
*
Belt
Flogger
Cane
Crop
Paddle
Spanking
Whip
Bruises
Bleeding
Face Slapping
Other
Health Information (Medications & Conditions)
*
If requesting anal play tell me your experience both with toys and real cocks.
Previous Submissive Experience (Both Pro and Personal)
Soft and Hard Limits & Any Extra Information.
*
How did you find Mistress Lupita
*
Terms and Consent, you MUST Accept to Session
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INFORMED CONSENT STATEMENT; I am requesting and at my own risk participating in a BDSM session. I understand activities within the Session will be conducted by mutual consent. I accept sole responsibility to; (a) decide what activities I wish to participate in during the Session and decide what my boundaries are. (b) communicate these decisions clearly before the start of the Session. (c) agree to an appropriate safe word or other signal to request an activity stop. (d) signal immediately, any unexpected fatigue, shortness of breath, chest discomfort, nausea, pain or discomfort. I understand I can discontinue participation at any time during the Session, without prejudice against me, beyond fees or tribute for the Session. LIMITS OF LIABILITY; I understand that any activity undertaken during the Session are voluntary and are at my own risk. I agree to indemnify and hold harmless all participants in the Session from all claims of liability, injury, death, property loss or damage, attorney’s fees and costs and I agree to reimburse them for any such claims; of same, they may have. AGREEMENT; by checking the box and submitting this session application, I acknowledge I have read, understood and agree to the contents of this form and I confirm that all information given by me, is correct to the best of my knowledge. I understand there is no sex involved in Mistress Lupita's sessions, I am a consenting adult over the age of 18 and I am not a law enforcement officer or federal law enforcement agent.
Signature
Submit to Mistress
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