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NO SAME DAY APPOINTMENTS!

Items marked with a red asterisk are required.

This form is for serious inquiries only. If you do not intend to schedule and show up for a session, do not use this form.

If you provide false, incomplete, or misleading information, you will be banned from Chicago Dungeon forever.

This form is encrypted and the information you provide is forwarded securely to a private email account, so your information is perfectly safe. After your session, your form will be permanently deleted, so your information has no chance of falling into the wrong hands.

WILL WE CLICK?

IF YOU ARE MATURE - I AM TALKING ABOUT ATTITUDE HERE, NOT YOUR CHRONOLOGICAL AGE - AND INTELLIGENT, WITH A RESPECT FOR DISCREET, SAFE, AND LEGAL PLAY, AND YOU LOVE TO LAUGH, WE WILL CLICK. IF YOU TAKE KINK TOO SERIOUSLY, I WILL FIND YOU TEDIOUS. IF YOU ARE PRETENTIOUS, I WILL FIND YOU A BORE. SMILE! IT'S JUST KINK!

Name as it appears on your government-issued ID*

First NameMiddle InitialLast Name

Mobile Number*

If you have a non-US phone number, enter a series of ones in this field, then enter your real foreign mobile number in the comments section below.

Email Address*

Confirmation Emailex: username@example.com

City*

ex: Chicago

State

Canadian Province

Country*

Occupation*

You do not have to be specific. I just want a general idea.

Gender*

Date Of Birth*

MonthDayYear

Ethnicity*

The following four questions help me determine your size, so I can prepare for your session with appropriately sized items. For example, when choosing a straitjacket or patient gown.

Height*

ex: 5'08"

Weight*

ex: 183 lbs

Waist*

ex: 38"

Chest*

ex: 40"

Disabilities/Physical Anomalies/Allergies/Medical Conditions (which may affect your session)

How did you find my website (e.g. Max Fisch, Dickie Virgin, Google, Yahoo!, Bing, FetLife, etc.)?*

If you saw a professional dominatrix within the last year, enter her website here.

Pick your poison.*

Check my calendar before you complete this question. What arrival date and start time is your first choice for our session? What date do you wish to see me? If you do not know yet, do not fill out this form. Wait until you decide on a date. I DO NOT DO SAME DAY APPOINTMENTS! I NEED AT LEAST 24 HOURS NOTICE!*

DateHourMinutesAM/PM Option

How long of a session do you desire?*

I require a 50% non-refundable deposit for all sessions. If you have to reschedule your appointment, your deposit will be applied to your rescheduled session. Which deposit payment method do you wish to use to secure your session?*

Comments: This is the place to mention special requests like what I wear, what you are into, et cetera. If you mention illegal activities like sex acts (prostitution, "jobs", etc.), body worship (facesitting, rimming, etc.), penetration (fisting, dildos, strap-on, etc.), massage, or forced bi, your form will be deleted and you will be permanently banned from seeing me. I run a clean dungeon. I remain fully-clothed during our session. You are definitely unworthy of sexual contact with me.

Do you understand and agree that this form is intended to schedule a session for professional BDSM and fetish exploration, and that penetration, prostitution services, massage, sex acts, etc. are not offered? (Please, note that if you act like a lunatic and request an illegal act during your session, you will be removed from the premises and forfeit your session fee. Please, don't embarrass yourself by exhibiting your desperation and willingness to be a turd.)*

YesNo

By signing this form you agree that you are not seeking sexual or illegal services, of any kind.*

Electronic Signature - use your cursor or finger, depending on your device, to sign your name on the line shown above. Just do your best. Clear

BEFORE YOU CLICK THE SUBMIT BUTTON, BE CERTAIN THAT YOU TRULY WANT THE APPOINTMENT FOR WHICH YOU ARE APPLYING. IF YOU JUST SEEK INFORMATION, SIMPLY EMAIL ME. THIS FORM IS FOR SCHEDULING APPOINTMENTS. ALL OTHER BUSINESS IS HANDLED VIA EMAIL OR TELEPHONE. NOTE THAT PEOPLE WHO FILL OUT THIS FORM WITH NO INTENTION OF ACTUALLY SEEING ME WILL BE PLACED ON MY TIME-WASTER LIST.

To prove you are human, type the crossed-out word you see below into the space below it. If you can't read the image, use the refresh button, which is the blue circular arrow.*