New Client Session Application
In order to approve your application, please answer the following questions as thoroughly as you are able:
Email address *
Legal name (first and last): *
Your answer
What name do you go by conversationally?
Your answer
Age:
Your answer
Date of birth: *
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Telephone Number (optional)
(Please note, I will NOT call you unless we have previously discussed and agreed.)
Your answer
Gender: *
City and State of legal residence:
Your answer
City and State you currently live in: *
Your answer
Are you willing to provide me a copy of legal identification as part of this approval process? *
Your identification as a client will be as private and secure as with your physician, whether you are a state senator or the guy who lives across the street. However, for my own safety I will be unwilling to meet any clients without having confirmed their true identify. Submission of ID will be required when the date of the session is formally booked.
As I do not take in-calls, if application is approved, where would this session take place? *
Please include city, if it would be your personal residence or a hotel, etc.
Your answer
Which session type are you applying for? *
Why are you applying for a session with me specifically instead of another disciplinarian? If from out of state, why me instead of a disciplinarian closer to where you live?
Your answer
Please tell me the preferred date/dates you'd like to book your session: *
Note: I am most able to book sessions from Friday evenings through Sunday. There are occasional weekday mornings or evenings where I am able to book, however, there is a slight surcharge for these sessions.
Your answer
Spankings in Your Childhood
Please answer the following questions about your childhood. It is critical that I have an accurate and true
understanding of your history, so please answer honestly.
Did you get spankings in childhood? *
If so, who primarily spanked you?
In hindsight, how would you describe the spankings you got as a child?
Please check all that may apply:
How would you describe your relationship with your mom in childhood? In adulthood? *
Your answer
How would you describe your relationships with other significant women in your life throughout the years?
Your answer
Your Discipline Needs Today
While you may still be discovering yourself, please answer the following to the best of your ability:
When/how did you become aware that you needed spanking in your life? How would you describe your needs today? *
Your answer
Will this be the first time you've experienced a disciplinary/punishment spanking as an adult? If no, tell me about any significant experiences you've had and how they have shaped you: *
Your answer
Which areas of your life would you like to work on through accountability and discipline? *
Required
How do you think my services will help you and positively impact your life?
Your answer
Have you read through the FAQ section on the site? Do you affirm that you are aware of what is off-limits from my standpoint, understand my policy on safe-words, etc.? *
Do you have any medical conditions that I need to be aware of so that I can ensure your health and safety?
i.e: heart conditions, history of stroke or high blood pressure, autoimmune, issues with bruising or bleeding, etc.
Your answer
Do you have any final thoughts or things you'd like me to know as I consider your application?
Your answer
I understand this is NOT a sexual service and that you have zero-tolerance for any sexually inappropriate behavior. I understand that my first offense will result in immediate termination of the session, that there will be no refund, and that my status as a client of Maia's will be immediately terminated. *
Required
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