Mommy Madeline's ABDL Nursery Session Booking Form

SCHEDULE A SESSION WITH MOMMY MADELINE AT HER ABDL NURSERY IN CHICAGO.

CHECK SESSION AVAILABILITY USING MY CALENDAR.

Items marked with a red asterisk are required.

If you provide false, incomplete, or misleading information, your form will be deleted, and you will be banned. I do not suffer fools gladly.

This form is secure. That is what the lock icon in your browser's address bar means. All information you enter on this form is encrypted, then sent to my secure gmail account via encrypted email.

After I process the data from your booking form, I permanently delete it. In addition, I never write anything down, so your information cannot be intercepted, hacked, or read by prying eyes. Your session info is stored in the calendar on my secure iPhone, which can only be opened using my passcode.

Your privacy, security, and safety are extremely important to me.

I run a legitimate business. If you are looking for sex, there are plenty of nice escorts who can accommodate you. I cannot accommodate you.

I do not drink, smoke, or do drugs. Recreational marijuana is legal in Illinois. Twenty-one is the legal drinking age. I do not allow smoking in my house. Please, adhere to Illinois state laws during your visit.

My facility is smoke free. A visit to my nursery may be an ideal opportunity for you to quit smoking.

My facility is free of illicit drugs. No hard drugs are allowed on the premises. Hard drugs are stupid. You may bring Rx and OTC drugs, like aspirin, antihistamines, prescribed medical marijuana, et cetera.

I do not drink alcohol. Alcohol numbs. You want to fully experience and remember your session, so I discourage the use of alcohol. If you think you need it to relax, you are wrong. I can relax you in less than a minute, using covert hypnosis. You will feel very calm, while you're under my care.

There is a delay of up to 12 hours from the time you submit your form, until the Internet gods deliver it to me, so same day appointments are impossible.
Name*

First NameLast Name
Preferred Contact Method*

TelephoneE-mail
E-mail Address*

Confirmation Email
Mobile Phone Number*
If your mobile phone number has a format other than the standard North American 10 digits, please enter it in the comments field below and enter ten 1s here.
City (as it appears on your government-issued ID)*
State (as it appears on your government-issued ID)
Canadian Province
Country*
Occupation*
Date Of Birth*

MonthDayYear
Ethnicity*
Gender*
How Do You Identify? (Check All That Apply)*

ABDLAdult BabySissy BabyDiaper LoverDiaper FetishistInfantilistAge PlayerLittleMiddleSissySpankoBabyfurRubber BabyPlastic BabyRole PlayerBratAll Of The AboveNone Of The AboveOther
My Demeanor During Your Session*

Kind & NurturingStrict & DemandingA Little Bit Of Both
My Role During Your Session*

MommyGrannyAuntieSisterBabysitterNannyGovernessNeighborDisciplinarianNunNurseTeacherSecretaryBossMistressTherapistHypnotistOther
Are You Into Humiliation?*

YesNoUnsure
Age You Wish To Play During Our Session *

InfantToddlerPre-SchoolKindergartenElementary SchoolMiddle SchoolHigh SchoolCollegeUnsureNot Applicable (not an age-player)Other
Discipline*

Mouth-SoapingCorner TimeTime Out StoolFace-SlappingOTK SpankingScoldingPaddlingNapEarly To BedEar-MarchingBondageWithholding MealsElectro-DiaperSent To RoomNone (don't want to be punished)Other
Do You Desire An Outing (going out in public)?*

YesNoUnsure
Are You Medically Incontinent (in other words, do you have a MEDICAL CONDITION that prevents you from being able to control your urine flow and/or bowel movements)?*

Urinary IncontinenceFecal IncontinenceBothNot Applicable
Allergies*

LatexTalcLactoseGlutenBee StingAnimalFoodSeasonalNoneOther
Disabilities/Physical Anomalies/Medical Conditions which may affect your session
Height (I need this to fit you properly)*

Less than 5’5’5’1”5’2”5’3”5’4”5’5”5’6”5’7”5’8”5’9”5’10”5’11”6’6’1”6’2”6’3”6’4”6’5”6’6”Greater than 6’6”
Weight (I need this to fit you properly)*
pounds
Waist Size (I need this to fit you properly)*
inches
Chest Size (I need this to fit you properly)*
inches
Dietary Restrictions (I can accommodate any diet)*

PescetarianPollotarianFlexitarianVegetarianVeganPaleoGluten-FreeDairy-FreeKosherHalalMacrobioticMediterraneanKetoDASHNoneOther
How did you find my website (e.g. Max Fisch, Dickie Virgin, Google Search, Yahoo! Search, Bing Search, FetLife, TalkToMe, Twitter, Instagram, YouTube, SnapChat, Personal Referral, etc.)?*
What arrival date and time is your first choice for our session?*

MonthDayYearHourMinutesAM/PM Option
How long of a session do you desire? You don't have to stay for the entire time you schedule. If you wish to leave before the appointed end of your session, that's fine.*
I require a 50% non-refundable deposit for all sessions. If you have to reschedule your appointment, your deposit will be applied to your rescheduled session. Which deposit payment method do you wish to use to secure your session?
If you saw a professional mommy within the last year, enter her website here.
Did you check the calendar on my website to verify that I am available on the date you are requesting?*

Yes, I'm well-behaved.No, I'm belligerent.
Comments: This is the place to mention special requests.
If you have a foreign mobile phone number, enter it above.
Do you understand and agree that this form is intended to schedule a session for professional fetish exploration, and that penetration, prostitution services, nudity, massage, sex acts, et cetera are not offered? Please, note that if you act like a lunatic and request an illegal act during your session or you get grabby, you will be removed from the premises and forfeit your session fee. Please, don't embarrass yourself by exhibiting your desperation and willingness to be a turd.*

YesNo
By signing this form, you agree that you are not seeking sexual or illegal services of any kind.*

Clear
Electronic Signature - use your cursor or finger, depending on your device, to sign your name on the line shown above.
BEFORE YOU CLICK THE SUBMIT BUTTON, SHOWN BELOW, BE CERTAIN THAT YOU TRULY WANT THE APPOINTMENT FOR WHICH YOU ARE APPLYING. IF YOU JUST SEEK INFORMATION, SIMPLY E-MAIL ME. THIS FORM IS FOR SCHEDULING APPOINTMENTS. ALL OTHER BUSINESS IS HANDLED VIA E-MAIL AND TELEPHONE. NOTE THAT PEOPLE WHO FILL OUT THIS FORM, WITH NO INTENTION OF ACTUALLY SEEING ME, WILL BE PLACED ON MY TIME-WASTER LIST.
Look below. See the word with a line through it? Type that word into the blank space below it to prove you are human. Can't read the word? Use the blue arrow refresh button next to the blank space to get a new word.*
Should be Empty:

SCHEDULE A SESSION WITH MOMMY MADELINE AT HER ABDL NURSERY IN CHICAGO.

CHECK SESSION AVAILABILITY USING MY CALENDAR.

Items marked with a red asterisk are required.

If you provide false, incomplete, or misleading information, your form will be deleted, and you will be banned. I do not suffer fools gladly.

This form is secure. That is what the lock icon in your browser's address bar means. All information you enter on this form is encrypted, then sent to my secure gmail account via encrypted email.