You are about to embark upon the journey of a lifetime! Remember, once you fill in the form and press SUBMIT, you hand over control of your next release to me!

 

Here are your instructions:

 

1.      Fill in the Application for the Chastity Program below completely including the name which I will address you by, as well as making sure you give me a valid email address.


2.      Once I receive your payment and completed Application for the Chastity Program I will confirm the commencement date of your Chastity period along with your initial instructions. Stand by and be ready to obey me completely. If you follow my instructions properly you will receive permission and timely instructions for your release.

 

3.   It's easy, simply fill in the Application below and wait for instructions. I will send you your program within 3 working days of receiving your Application and fees.

 

4.   Once you submit your Application you will then be taken through to a page where you can pay your fees for your Chastity Program. If I receive an Application for the Chastity Program where no fees have been paid your Application will simply be rejected, obviously.  

 

The Application for the Chastity Program below must be fully completed with all questions answered. Where a form is not duly completed it will be automatically rejected.

Application For Mrs Birch's Chastity Program - FORM ACP 1B

 

Personal Details:

 

Name:

Preferred Name:

Age:

Marital status:

Email address:

Country you reside in:

State/County/Province

Nearest City:

Build

Height:

How much time do you have each week to devote to tasks I may set for you during your Chastity program?

Length of penis:

Erect: Flaccid: inches

Girth of penis:

Erect: Flaccid: inches

Colour of Pubic Hairs:

Have you ever shaved your pubic hair?

Are you able to shave your pubic hair?

Length of hand from wrist to tip of middle finger?

inches

Are you right or left handed?

Do you bite your nails?

Fetishes you have experienced (check as many as you wish)::

Chastity
Tease and Denial
School Discipline
Domestic Discipline
Petticoat Discipline
Nursery Punishment
Corporal Punishment
Written Impositions
Embrocations
Cock and Ball Torture
Penis Discipline
Anal Play
Bi Sexual or Bi Curious
Public Humiliation
Sissy Maid Training
Cross-dressing
Cuckold
Clippering, Head Shaving
Bondage
Foot Worship
Slave Training

Fetishes you wish to try but have not yet done so (check as many as you wish):

Chastity
Tease and Denial
School Discipline
Domestic Discipline
Petticoat Discipline
Nursery Punishment
Corporal Punishment
Written Impositions
Embrocations
Cock and Ball Torture
Penis Discipline
Anal Play
Bi Sexual or Bi Curious
Public Humiliation
Sissy Maid Training
Cross-dressing
Cuckold
Clippering, Head Shaving
Bondage
Foot Worship
Slave Training

How would you describe yourself, eg, are you submissive and totally obedient? Rebellious?
In need of strict discipline? Hopelessly addicted to masturbating and in desperate need of control?

What is the most humiliating thing that has ever happened to you sexually?

What is your most enduring sexual fantasy?

List your 3 favourite fetish web sites (not counting this site):

1.
2.
3.

List your 3 favourite fetish magazines:

1.
2.
3.

What is your previous experience or fantasy related to being in servitude to a Mistress?

Release Details:

 

Date you last ejaculated:

List the 5 previous occasions to the above:

1.
2.
3.
4.
5.

 

What benefits will you receive by undertaking a period in Chastity?

List 3 reasons why this request should be granted?

1.
2.
3.

List 5 preferred dates on which you would like to obtain release.
*Please note, your requested dates may or may not be granted.

1.
2.
3.
4.
5.

Which hand do you like using?

Are you currently collared or in anyway or under the Domination of another which would prevent
you from being available to complete assignments or tasks given to you during your Chastity?

Advise where you’d like to be when released:

What area do you like to use for release?

What position do you like using to masturbate?

Do you like fast or slow strokes?

How long do you like to take?

minutes

What do you like to fantasise about when you are masturbating?

Describe the images you like to look at while masturbating?

Do you like using a mechanical aid when masturbating?

What do you normally do with the ejaculate?

How do you clean up afterwards?

What do you consider really embarrassing or humiliating?

 

Agreement MUST be read before submitting your Application. In sending, you are agreeing to all conditions of the Agreement.

Dear Mrs Birch


I hereby humbly submit my Application for inclusion in Your Chastity Control Program and respectfully request that You consider granting my release at Your complete and absolute convenience.


I respectfully give to You my commitment to remain in a state of Chastity until instructed by You to release via a method determined by You.

I promise to refrain from touching, fondling or partaking of any unauthorized activity involving my ‘little willie’ during my period spent in Chastity.

If at any time I fail in my commitment to refrain from partaking of any unauthorized activity involving my ‘little willie’ I will inform You immediately by email and leave myself open to Your absolute Mercy.


I understand I will be given tasks and Assignments to complete throughout my period spent in Chastity and I undertake to complete all given to me willingly and without complaint. I fully understand that failure to complete any tasks or Assignments given to me by You during my period spent in Chastity may result in my release date being severely penalized.


I hereby state that I am physically and mentally sound, and will not hold you, Mrs Birch responsible or liable for any injuries real or perceived resulting from my use of any Chastity Device I may use during the term of this Agreement.


If I join the Program and choose to use a Chastity Device I will use it in accordance with the manufacturers instructions, recommendations and advice on how to use the device. I understand that Mrs Birch is not in any way responsible for the manufacture of any such device. 

 

All applications will be dealt with in order of receipt.

Copyright Mrs Birch 1998 - 2017 

No part of Mrs Birch’s Application for Chastity Control FORM ACC 1B may be reproduced or transmitted by any means, electronic,
mechanical, photocopying or otherwise without prior written consent from Mrs Birch