logo

Strict Jane Application Form


Strict Jane New Client Application

Name
Although I strictly adhere to client confidentiality, Aliases are acceptable.
Email *
Phone Number

###
-
###
-
####
I will respond via email. Your phone # is for emergency or booking related issues only.
City, State
Gender
 Male 
 Female 
Age Range
Are you also interested in Life Coaching?
 Yes 
 No 
What experience do you have with discipline as an adult?
Personal Introduction - Tell me about yourself... *
eg. History with spanking, details of your ideal session, favorite implements, anything you feel guilty about, or why you feel my service would be beneficial. The more you tell me about your spanking needs and interests, the better your session will be.

As a professional, I do adhere strictly to Client Confidentiality. Anything you tell me will remain private.
By selecting the below in the affirmative, I agree I have read, understood and comply with the following statement of service.
 Yes. 
Strict Jane provides traditional Physical Discipline within a legitimate and platonic structure that strictly follows legal guidelines. As a client, you will be afforded complete privacy, discreetness and respect, and your consent will be asserted by hand prior to commencement of any discipline. Requests for sexual services are illegal and will not be tolerated.

Once you have filled out the form, click the "SUBMIT" button.

Please submit the form only once. You may email me if you have anything further to add.