Prison Stay Completion Form

For those wishing to be part of my prison stay experience. Please complete the form in detail and do not withhold any medical conditions / emergency needs. Make sure all the information provided is accurate and true.

Name / Profile Name *

Email *

Country and City *

Age

Gender

Do you have any allergies?

Yes (please specify)
No

List your allergies and medication you need to take in case of emergencies

Do you take any medication? If yes, please list below and what the medication is for.

Do you have problems or limitations on the movement such as back problems; joint issues like arthritis; knee problems and problems with the spine? If yes, please list below.

Do you wear things that need to be removed such as contact lenses, braces, hearing aid? If yes, please list below

Do you have health problems that may affect your time in the prison such as with heart, epilepsy, diabetes or others? List all and in detail.

Do you have any phobias? If yes, please list

BDSM Experience: How many months/years have you been interested in / participating in BDSM activities?

What kind of experience have you had?

Which activities do you enjoy engaging in the most during a session?

What is the longest session you have had and what did it involve?

Have you even done a session for a 48 hour period?

Bondage: Experience

Little to No experience
Some experience
Very experienced

Bondage:

How important is bondage to you during a session? What form of bondage do you enjoy the most?

Impact Play: Experience

Little to no experience
Some experience
Very experienced

Impact Play: Intensity Level

Impact Play:

My body can be marked and bruised
Some markings / bruising in specified areas
No Marks or Bruises

Anal Play: Experience

Little to no experience
Some experience
Very experienced

Anal Play: Intensity Level

Easy / gentle (fingers and small plugs)
Intermediate (fingers, average size plugs or dildos)
Advanced (fists, large plugs / dildos)
Important in my session
Not necessary in session but would be welcome
DO NOT want to be forced to penetrate another male anally
I am open to being forced to penetrate another male anally
I DO NOT want to have another male penetrate me anally
I am open to having another male penetrate me anally

Electrical Play (Experience and Intensity Level)

Easy / gentle
Intermediate (have had experience with Electro play
Advanced (have had intense electric play, cattle prod, tens unit, etc)
Important in my session
Not necessary in session but would be welcome
Do NOT want electro play part of my session

CBT (Cock and Ball Torture)

Easy / gentle (dont hurt my balls, but touch it gently)
Intermediate (have had experience with CBT)
Advanced (have had intense CBT play, balls busted, squashed, pulled, kicked, etc)
Important in my session
Not necessary in session but would be welcome
Do NOT want CBT to be part of my session

Medical Play

Never done Medical play before and DO NOT want to try
Easy / gentle (never had any experience or very little)
Intermediate (have had experience with medical play such as needles, saline injections, examinations / internal inspections, catheters)
Advanced (have had plenty of experience with medical play such as needles, saline injections, examinations / internal inspections, catheters)
Important in my session
Not necessary in session but would be welcome

Water sports

Never done watersports before and DO NOT want to try
Easy / gentle (never had any experience or very little)
Intermediate (have had experience - been pissed on / have drunk pee))
Advanced (have had plenty of experience with water sports)
Important in my session
Not necessary in session but would be welcome

Food / Meal considerations *

Food during your stay will be basic. 3 Meals a day. If you have any dietary consideration please let me know. This includes intolerance to gluten, dairy, vegan, vegetarian, etc. If none, state 'None"

Extra comments / Details I should know.

Please explain in detail anything else related to your stay in the prision that I need to be aware of that was not clearly covered in the form above.

Mistress April may want to film parts of your stay for her website and promotional material. Please indicate below your preferences.

I consent to be filmed as part of Mistress April's promotional material and website footage and give permission to her to have my face and body in view.
I consent to being filmed as part of Mistress April's promotional material and website footage ONLY if I am wearing a full face mask and I am unrecognisable.
I do NOT consent to being filmed during my stay at the Prison.

Declaration

I agree that all information that I have entered into the form is accurate and true.
I am aware of the health and psychological risks involved and I understand that I have entered into the role play/fetish fantasy activies at my own risk
I undestand that should I WISH to use the safe word "Red" that all activities that involve me, will end and I will be allowed to leave the prison. Leaving means I forfeit my deposit.
I acknowledge that I have read and understand all of the above and have made knowledge of anything that may not be highlighted here.

Name *

First

Last

Date

dd/mm/yyyy

Signature