Name
*
Work name
*
Street Name + House Number
*
City
*
Date of birth
*
-
Month
-
Day
Year
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Nationality
*
Length (in cm)
*
Weight (in kg)
*
Bra size
*
Clothing size
*
How good are you in Dutch?
*
Please Select
None
Average
Good
Fluent
How good are you in German?
*
Please Select
None
Average
Good
Fluent
How good are you in English?
*
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None
Average
Good
Fluent
How good are you in Spanish?
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Please Select
None
Average
Good
Fluent
What other languages are you fluent in?
KVK Registry Number (if you don't have any, are you willing to get one?
*
Do you smoke?
*
Please Select
Yes
No
Only with clients
Sometimes
Do you consume alcohol?
*
Please Select
Yes
No
Only with clients
Sometimes
Do you take drugs?
*
Please Select
Yes
No
Only with clients
Sometimes
Select all services you provide as an escort:
*
Casual sex
Oral sex with condom
Erotic massage
French kissing
Golden shower
Threesome with men
Threesome with a couple
SM roleplay
Overnight stay
Dinnerdate
Going out to party
Receive oral sex
Position 69
Striptease
Roleplay
Client can bring toys upon request
Body to body massage
Nuru massage
Business event or trip
Tantra
Bondage
Girlfriend experience
Squirting
Oral sex without condom
Fingering
Strap on dildo
Anal with condom
Deepthroat
Rimming
Other
Is it your own choice to start with this job?
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Yes
No
Do you need to give a part of your income to another person?
*
Yes
No
Are you free from any STD’s (sexual transmittable diseases)?
*
Yes
No
When did you last tested on STD's?
*
I know that the agency has told me that I can refuse sexual acts that I don’t want to perform on the client.
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Yes
No
I know that the agency has strongly recommended me that all sex will be ‘safe’
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Yes
No
I know that the agency has told me that i can refuse (extra) services that i don’t want to do, when a client wants me to.
*
Yes
No
I am choosing this job out of my own free will and without any force or pressure from any other person or company.
*
Yes
No
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Phone Number
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Format: (000) 000-0000.
Email
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