Dragonfly's Den Membership Application

The information below is required to process your Dragonfly's Den membership application. This information will never be shared with others outside the Dragonfly's Den management team. This information, including email address, will not be sold, traded or relinquished to any merchants or organizations.

Todays Date Month Day Year
General Information
Your Name First Last
Scene Name
Use your scene name in correspondence? Yes_No_Indifferent
Date of Birth Month Day Year
I confirm that I am over 18 years of age Yes_No
Phone (including area code) Home Cell Other
Email
Do you wish to recieve Dragonfly's Den information via email? Yes_No
Use email to send you important information? Yes_No
Mailing Address StreetCity
Province/State Postal/Zip Code
Emergency Contact NamePhone (area code)
Relationship to you
Health Information
To ensure the safest environment for our clients and staff we require you to indicate any health situations that you may be experiencing. Please include any physical or psychological, present or past items, which could influence or affect your ability within the activities of the Dragonfly's Den.
Do you have any allergies? Yes_No
If yes, what are they -
Do you take any medications that we should be aware of? Yes_No
If yes, what are they -
Do you have any past traumatic experiences that we need to be aware of? Yes_No
If yes, what are they -
Confirmation and Signature

1. Signing this agreement indicates that I have read the Dragonfly's Den Official Policies and Rules, and that I hereby agree to act in accordance to those policies and rules while on the Dragonfly's Den premises.

2. I agree that, since the Dragonfly's Den is a private BDSM club, safety and confidentiality are the two most important requirements for being a Dragonfly's Den member and I will act to preserve the safety and confidentiality requirements set out by the official policies and rules. When a decision has to be made regarding the safety and confidentiality of actions within the Dragonfly's Den, while I may not agree with the decision, I will follow the choice of the Dragonfly's Den management team in that moment and raise my concerns when the situation is better suited.

3. I understand that a copy of this form will be kept at the Dragonfly's Den and will not be released to anyone for any circumstances, unless necessary to ensure the health and safety of myself or others, or under situations that deem it legally necessary to do so.

4. I understand the risks involved partaking in the BDSM and other activities at the Dragonfly's Den. I take full responsibility for my actions and expressions, and I release the Dragonfly's Den from any and all responsibility for any physical or emotional injury/harm, dismemberment or death that may occur to me or any individual that I bring to the Dragonfly's Den as my guest.

5. I accept that, if I do not follow the official policies or rules of the Dragonfly's Den, I may be subjected to the enforcement outlined in the official policies and rules, which may include termination of my membership. I also accept that, if any of my actions or expressions outside of the Dragonfly's Den risks the safety or confidentiality of others who work at, are members of, or visit the Dragonfly's Den, my membership may be terminated.

6. If for any reason I do not wish to continue with my membership at the Dragonfly's Den, it is my responsibility to inform the management team. I recognize that the Dragonfly's Den will still keep my information on file, unless I specifically ask for it to be removed from their files.

7. It is my responsibility to inform the Dragonfly's Den of any changes on this form.

8. I recognize that if any of the information I have provided is found to be false, this may be grounds for termination of my membership.
All the information I have entered above is considered true to the best of my knowledge. Yes No
Type your name as your electronic sigmember:namsternature
We thank you