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NAME_________________________________________________ DATE_____________________

OTHER NAMES USED_______________________________________________________________

HEIGHT______ WEIGHT________ VITALS_____________ HAIR_____ EYES_____ AGE________

OTHER PLACES YOU HAVE WORKED___________________________________________________

                  GIVES       TAKES     RESTRICTIONS/REMARKS
BONDAGE         5 4 3 2 1 0 1 2 3 4 5 _________________________________________

DOMINATION      5 4 3 2 1 0 1 2 3 4 5 _________________________________________

LONG TERM SESS. 5 4 3 2 1 0 1 2 3 4 5 _________________________________________

SPANKING        5 4 3 2 1 0 1 2 3 4 5 _________________________________________

WHIPPING        5 4 3 2 1 0 1 2 3 4 5 _________________________________________

                HEAVY LIGHT LIGHT HEAVY
BROWN SHOWERS    ( )   ( )   ( )   ( ) ________________________________________

ENEMAS           ( )   ( )   ( )   ( ) ________________________________________

  -BARDEX        ( )   ( )   ( )   ( ) ________________________________________

  -COLONICS      ( )   ( )   ( )   ( ) ________________________________________

  -NURSE FANTASY ( )   ( )   ( )   ( ) ________________________________________

GOLDEN SHOWERS   ( )   ( )   ( )   ( ) ________________________________________

INFANTILISM      ( )   ( )   ( )   ( ) ________________________________________

LEATHER WEAR     ( )   ( )   ( )   ( ) ________________________________________

     EQPT OWNED________________________________________________________________

RUBBER WEAR      ( )   ( )   ( )   ( ) ________________________________________

     EQPT OWNED________________________________________________________________

TRANSVESTISM     ( )   ( )   ( )   ( ) ________________________________________

     EQPT OWNED________________________________________________________________

MODELING:  WILL POSE  PHOTOS OK
BONDAGE       ( )          ( ) ________________________________________________

LINGERIE      ( )          ( ) ________________________________________________

NUDE          ( )          ( ) ________________________________________________

HOUSE WORK IN EXCHANGE FOR SESSIONS  ( ) YES         ( ) NO

REMARKS________________________________________________________________________

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