Application Form for Submissives
This form is for Face to Face sessions
For further questions, email Me at; Lady.Domina@iCloud.com
Name
*
First Name
Email
*
Confirmation Email
example@example.com
Phone Number
*
Please enter a number contactable on WhatsApp - If you're outside the UK, enter your area code.
Format: (000) 000-0000.
Suggested date to discuss session details
*
-
Month
-
Day
Year
Date
Suggested session date
*
-
Month
-
Day
Year
Date
Do you understand that Miss Jazsmine's sessions do NOT include sexual activity?
*
YES
NO
Why are you interested in serving Miss Jazsmine?
*
How much experience do you have as a Sub? Do you have any Dommes that can give you a reference?
*
PROVIDE YOUR CURRENT OR PREVIOUS DOMMES SOCIAL MEDIA
What is your preferred type of Domination
*
Sadist
Sensual
Bratty
Strict
Humiliating
What is your Pain level
*
Please Select
I do NOT like pain at all
Light
Moderate
Intense
Extreme (Consent Form Required)
What are your Kinks/Fetishes?
*
Ass Worship
Ball Busting
CBT
Chastity Contract/Erotic Sexual Denial
Cuckolding
Domestic Servitude
Edging
Encourage Bi-Play
Foot-Worship
Flogging
Golden Showers
Good/Bad Pain
Human Furniture
Pegging/Anal Play
Sensory Deprivation
Spanking
Sadism
Other
Tools desired
*
Blindfold
Cane
Chastity cage
Collar
Flash-light (Fake Vagina)
Flogger
Leash
Mouth-Gag
Strap-on
Whip
Rope
Feminine Wear (Dresses, Heels, Make-Up)
NONE
Physical Limitations? i.e bruising, markings etc
*
Do you consent to images/videos during the session, if your Identity is concealed?
*
YES
NO
Submit
Should be Empty: