Whipstock Grange Enrolment Form
Name : Pseudonym :
Address :
Date Of Birth :
E-mail : Telephone : Mobile :

Please indicate how you would like to be contacted : E-Mail     Telephone     Mobile


What age would you like to play during your day at Whipstock Grange? years old
Do you already participate in any form of corporal punishment activity? Yes  No
If 'Yes', at what level would you say you like to receive Punishment? Mild Medium Hard
Is it a problem for you to have punishment marks on your bottom? Yes No
After a reasonable warm up would you like your limits to be pushed a little? Yes No
Do you like a mild spanking to the top of your thighs? Yes No
Please indicate any implements you CAN'T take Slipper Paddle Strap Cane Birch
Apart from the schoolmistress would you like to be punished by the Headmaster? Yes No
If 'Yes', please indicate which punishment/s Slipper Paddle Strap Cane
If you require a uniform, please fill in the required sizes Waist  (inches)   Chest  (inches)
Do you have low blood pressure or any other ailment which may cause dizziness if you are bent over? Yes No
Are you on any medication which may hamper your role play or capability to receive corporal punishment? Yes No
If you answered YES to any of the last two questions, please explain
Declaration :
I am applying to become a member of Whipstock Grange. I am over 18 and whilst on your premises I may receive corporal punishment; I will not partake in any sexual acts whatsoever; I will not to bring or use any form of illegal drugs; I will not use any form of visual and/or audio recording devices
I agree to the above declaration Yes No
To prove you are a real person, please type in following word into the text box Are you human  

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