Your E-mail Address 

Session Date Requested  or the week of

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

Length of Session  Up to 1 hour Up to 2 hours Up to 3 hours About 4-5 hours Up to 6 hours Up to 8 hours Up to 12 hours Overnight

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 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. 3. 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. 4. 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 Mistress Kay, the location of da Dungeon, BDSM Sanctuary, and House of Sanctuary, LLC herein referred to as HOS. 5. 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. 6. I understand that Mistress Kay 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 Kay has had local law enforcement review the premises and Her practices to assure that her practices are within legal limits, as well as health concerns. I understand that Mistress Kay will keep all activities and my identity confidential. 7. I understand that I am not purchasing nor requesting any sexual acts or illegal activity. No sexual services are offered by Mistress Kay or at the location of da Dungeon. I shall not expect nor request any nudity, sex, acts of prostitution or any illegal act in any manner. 8. 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. 9. I understand that Mistress Kay 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. 10. 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. 11. I release and discharge Mistress Kay, 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. 12. I accept full responsibility upon myself while in the physical location of Da 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 Kay, HOS and the homeowner(s). 13. The areas at da 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. 14. I state that I will partake in any and all activities at my own risk and release and hold harmless Mistress Kay, the web site owner/operators, HOS, any other participants, as well as the homeowners of da Dungeon. I waive all responsibility for any injury that I may receive during any and all activities and/or events. 15. I agree to the Rules of Conduct as posted at "http://www.bdsmsanctuary.com/mistress_kay/rules_of_conduct.shtml" which I will follow while at da Dungeon or in the presence of Mistress Kay.

 I have read and I agree with the Rules of Conduct, terms and conditions .  Yes  

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

© 2008 House of Sanctuary, LLC Form