B A R O N E S S

Name*

Telephone number*

Email*

Date that are you looking to serve? All forms MUST be backed up with a telephone call! to confirm reciept*

Medical conditions if any?*

Age*

Build / Height / Weight*

Sexual orientation

Can you be marked?

Never Temporary / For a few days Indefinitley

What are your primary fetish interests

What equipment, activity or rolplay do you enjoy the most

What are your hard limits?

What best describes your mind during a session?

Suffering to please the Baroness A rite of passage Penitence Suffering against your will

Additional fetishes

Discipline

Spanking Caning Flogging Paddling Bull whipping Kicking Slapping Pinching Punching

Sensory Deprivation

Isolation Cell Blindfolds Gags Hoods Saran wrap

Cock and Ball Torture

Weights Stretchers Slapping Cock and ball bondage Cock and ball suspension Cock and ball pin lined corset and parachute Ball crushers Chastity devices Sounds

Water Sports

WS on genitals WS on body Enforced consumption Rebreather with piss infusuion

* Required

Personal Specification

Answer & tick the relevant categories.

If you do not fill in the boxes highlighted by an asterisk* the form will not send.

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