Your E-mail Address 

Session Date Requested  or the week of

Session Start Time Requested  Make a Selection start before 10am start between 10am-11am start between 11am-1pm start between 1:00pm-3pm start between 3:00-5pm start between 5:00-7pm start between 7:00-9pm start time after 9pm

Length of Session  Make a Selection Up to 1 hour Up to 2 hours Up to 3 hours Up to 4 hours Up to 5 hours Up to 6 hours Up to 7 hours Up to 8 hours Up to 12 hours Overnight Week-end A vacation

IF Mistress feels there is a connection, how many times per YEAR would you serve?

AGREEMENT, WAIVER, RULES of CONDUCT, TERMS and CONDITIONS. In pressing the submit button I do hereby apply my electronic signature and ente into this legally binding agreement. If a court of competent jurisdiction deems any portion of this agreement unenforceable it shall not affect the enforceability of the other portions of the agreement. I do hereby solemnly declare under penalties of perjury and affirm the following: 1. I am a safe, sane, and consensual adult over the age of twenty-one who fully understands that I am requesting to arrive at a location that is designed for the atmosphere of private adult practices of an alternative fetish lifestyle. I subscribe to the principles of the First Amendment, which holds that adults have the right to decide for themselves, what they read, do and view without governmental interference and that the activities that may occur are strictly a private matter between the consenting adults. 2. I agree to hold harmless and indemnify the home owners, all people that may be at the location, any and all of their employees, officers, directors, agents and, or assigns from any and all liability, direct, indirect, subrogated or not, vicarious, or otherwise, which may accrue as a result of any accident, injury, cause of action, or damage to my person or property, or any other damage of any kind as a consequence of my attendance and /or during a session. 3. I affirm I am neither a law enforcement officer nor working in cooperation with any federal, criminal, media, legal, private, or family service investigation. I sincerely guarantee that I am not seeking out evidence, which may serve as the basis for any charge of violating federal, state, or local laws. 4. I hereby certify that if I am in law enforcement or the media that I am solely attending only for person reasons and not as part of any investigation nor in any other official capacity. 5. I declare that I am not seeking to entrap or gather information for any sort of legal, criminal or family associated actions nor media related issues. I am solely responsible for any false disclosures or legal ramifications and accept that any legal fees occurring from any action shall solely be my responsibility. 6. I agree that all that I observe will be kept in the strictest confidence and I recognize this as a contractual obligation and that I will do nothing that may jeopardize the privacy and identities of any one I may meet there or in association from or even the location. 7. I will not disclose any information about the gift, tribute, or donation that I may make, the actions that transpire, nor the identity of anyone I may meet, to anyone whomsoever. I affirm I will not disclose any information nor make an implication of any activity that may occur. I accept that I am under the strictest confidentiality agreement and that by petition of court I would still refuse to disclose any information regarding any activities in association with any one or any business entity 8. Because of my very strong desire for privacy and confidentiality, and in consideration of the mutual promises and commitments…That if I do initiate, or participate in, any action, administratively, or at law, or in equity, or otherwise against the Organization for any information described in this document, or relating to possible disclosure of any information described in this document, I agree to pay, reimburse, and hold harmless HOS and anyone associated with this experience for any expenses, including any legal fees, it may incur in relation to such action regardless of the outcome of such action. 9. I certify that I am attending for my personal enjoyment and I understand that I will be exposed to BDSM, D&S, S&M fetish, lifestyle, and activities that some people might find offensive, but I hereby certify that I do not find such activities offensive. I consent to being exposed to such activities. 10. HOS is hereby defined as a business entity that produces web sites. HOS shall refer to and include, but not be limited to including, the web site owner(s), designer(s), operator(s), business owner(s), business affiliate(s), as well as any and all people in association with HOS. 11. I understand that Mistress is a safe sane consenting adult over the age of twenty-one and is not involved with any law enforcement, media, or government entity but abides by all legalities regarding her activities. I understand that Mistress will keep all activities and my identity confidential. 12. I understand that I am not purchasing nor requesting any neither sexual acts nor illegal activity. No sexual services are offered by Mistress or at the location of the Dungeon. I shall not expect nor request any nudity, sex, acts of prostitution nor any illegal act in any manner. 13. I understand that all donations, gifts, transactions, and tributes are non-refundable and since they are given as a gift or a donation that any on-line transaction using my bank account or credit card can not be reversed, refunded, or charged back for any reason. I am not making a gift or donation to be use against any person whomsoever in any conceivable manner. In making a gift, tribute, or donation I furthermore state that I shall be bound by this agreement for all future meetings. 14. I understand that Mistress and the homeowner(s) retain the right to refuse entrance to anyone for any reason. I understand that if I am intoxicated or suspected of being under the influence in any way that I will be asked to leave or refused entrance. 15. I agree to never bring any illegal content nor discuss illegal activities with anyone at the premises nor otherwise associated. No illegal substances, drugs, knives, firearms nor weapons of any kind are allowed on premises. 16. I release and discharge Mistress, the providers, operators, owners and creators of the web site, homeowner(s), as well as those individuals I may meet at this location from any and all liability that might arise. 17. I accept full responsibility upon myself while in the physical location of the Dungeon. Any injury that may occur shall be construed as an activity that I requested. Any accident liability I accept solely myself and for my heirs, waiving any and all liability from Mistress, HOS and the homeowner(s). 18. The areas at the Dungeon are personal spaces that may be offered for atmosphere such as for a photo shoot or a party but shall not be considered a business location but a space located in a private home. I shall respect the homeowners and not disclose the physical location, for any reason. 19. I understand that I may never go to the location except when a confirmed appointment is established. 20. I state that I will partake in any and all activities at my own risk and release and hold harmless Mistress, the web site owner/operators, HOS, any other participants, as well as the homeowners of the Dungeon. 21. I waive all responsibility for any injury that I may receive during any and all activities and/or events. If I do initiate or participate in any action legal, in equity, or otherwise against anyone in this document for any information described in this document, or relating to possible disclosure of any information described in this document, I agree to pay, reimburse, and hold harmless everyone personally and as presented as a business for any and all expenses, including but not limited to any legal fees, in relation to such action regardless of the outcome of such action. 22. I agree to abide by the Rules of Conduct as posted, as presented to me, or by verbal explanation.

 I have read and I agree with the terms and conditions .  Yes  

This will be reviewed and you will be contacted at the e-mail address given

© 2008 House of Sanctuary, LLC Form