JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Submissive Application Form
Answer & tick the relevant categories.
Sign in to Google
to save your progress.
Learn more
* Required
Name
*
Your answer
Email
*
Your answer
Phone Number
*
Your answer
Date That You Looking to Serve
*
MM
/
DD
Preferred Time of Session
*
Morning (9:00 am - 12:00 pm)
Afternoon (1:00 pm - 4:00 pm)
Evening (5:00 pm - 8:00 pm)
Night (8:00 pm - 11:00 pm)
Length of Session
*
1 Hour
2 hours
3 hours
4+ hours
How did you find My website?
Your answer
Medical Conditions (please be specific)
*
Your answer
Age
*
Your answer
Build / Height / Weight
*
Your answer
What you are looking to explore in the session?
*
Your answer
Hard Limits
*
Your answer
Experience
*
Submiting all my life
Dabble on Occasion
Complete Newbie
Marks
*
Never
Temporary
I want a permanent symbol from You
Fetishes
*
Your answer
How would you best describe you desires in relation to me?
*
I want to serve you, and do whatever you tell me to within my limits.
I only want to partake in a set of fetish activities that turn me on.
I want to be put in my place and humiliated.
I want to experience an emotional connection akin to a Female Lead Relationship
I want to be taught to be a good little submissive.
Required
Role Play / Fantasy Scenerio
Your answer
Trigger Words (words that get you off /names you would like to be called)
Your answer
Discipline Through Pain
OTK Spanking
Caning
Flogging
Paddles
Kicking
Face Slapping
Nipple Torture
Dragging my Deliciously Sharp Nails Across your Skin
Punching
Worship
Legs
Pits
Feet
Boots
Nylon/Shoe
Face Sitting/ Bum worship
Anal Play
Pegging
Butt plugs
Prostate Massage
Fisting
Bondage
Rope
Retraints
Genital Bondage
Cage
Full Body Bondage
Sensory Deprivation
Blind fold
Gag
Saran Wrap
Sensory Play
Tickling
Ice
Wax Play
Nipple Clamps
Wartenburg Wheel
Feathers and Fur
Deep Heat (or other similar products)
Abrasion
Genital Clamps
Estim
Violet Wand
Needles
Cock and Ball Torture
Sounding
Ball Slapping
Ball Crusher
Cock and Ball Bondage
Stretching
Ball Busting
Weights
Chastity Device
Tease and Denial
Ruined Orgasm
Submit
Page 1 of 1
Clear form
Never submit passwords through Google Forms.
Forms
This content is neither created nor endorsed by Google.
Report Abuse
Terms of Service
Privacy Policy