Supplication & Session Request Form
Fill out this form honestly, completely, and to the best of your ability. Yes, it's long and detailed. It will save much time, money and possible injury. Mostly it will clarify and communicate very important information.

Once I have read and evaluated your request for a session,  I will contact you by phone (and/or email) to inform you if we can meet.

I am a R.A.C.K -Risk Aware Consensual Kink- player and we will discuss everything including your safe word at the beginning of our time together. By filling out this form you are consenting to the activities you desire and are held responsible as a safe, sane and sober adult capable of making your own choices.
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Email *
Name: *
sub/pet name:
Phone: *
Discretion is demanded and assured. List any calling restrictions.
If you have Telegram list your handle here.
Age: *
Physical description:
Gender and gender goals:
Sexuality: *
Occupation & Employment: *
Where are you located? *
Are you married or in a relationship?
Do you smoke? *
Are you drug/disease free? If no, explain.
Include recreational drug use.
Explain any and all health issues. *
Whether or not you feel they will interfere in our time together is irrelevant.
When was the last time you were in the E.R. or hospital? Why? *
I need to know for both of our well-being.
you are seeking: *
check all that apply
Required
your interests include: *
check all that apply
Required
Describe your interests and kinks: *
Describe your experiences and with whom you had them:
include how long you have been involved in the scene.
What are your Hard Limits? *
Yes, you have them.
What level of marking is acceptable? *
Can you supply any references?
If so, list.
Are you involved in law enforcement in any manner? *
Be honest, I have & will scene with law enforcement personnel.
Are you willing to send Me a picture of your face?
Are you fully vaccinated & willing to provide a copy of your vaccination card? *
Required
How, where or from whom did you find Me & My website? *
Have you taken the time to read through My website?
Clear selection
What date(s) and for how long would you like to visit Me? *
If a tour date or outcall - What city are you wanting to book for?
*Note: I do NOT condone pedophilia, bestiality, necrophilia, or non-consensual acts of violence. Assault and rape are punishable offenses. This survey is used as a resource tool to gain more knowledge as to your experience, as well as your limitations.
All information is kept private and confidential.
I hereby certify that I am a sane and consenting individual, twenty-one (21) years of age or older. I do understand that this is a psychodrama and role-play service dealing in realism and creative expression only; that there is no nudity on the part of the dominants; and/or acts of prostitution; and/or acts of pedophilia, necrophilia, or bestiality condoned or practiced on the premises. I partake in any and all activities at my own risk. If I am employed by any government agency, I will disclose this information during our initial conversation. I also agree not to disclose any written, audio, or visual information regarding our time together or correspondence between us.   *
Required
Have you read & replied to everything?
Clear selection
Are you willing to make a deposit? *
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