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SESSION REQUEST FORM ~ HOUSTON

A submission of this form is required to formally request a session with Goddess Khiya.  
All information must be honest and factual.

If the submitted answers change, alert Goddess Khiya prior to the start of the session.

SESSION REQUEST DETAILS   

(GENERAL HOURS OF AVAILABILITY: Monday - Friday (12pm - 12am) / Saturday - Sunday (11am - 8pm)

I am submitting a request to schedule a session for:
12:00 PM

I have read and voluntarily agree to Goddess Khiya's Session Terms & Conditions. 

www.GoddessKhiya.com/SessionInformation.

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I understand that a 25% deposit of total session cost is required upon confirmation of a session date & time, with the remainder due at start of session.

WHAT ARE THE KINK/FETISH INTERESTS YOU WOULD LIKE TO EXPLORE?

BONDAGE Required
IMPACT PLAY Required
IMPACT PLAY TYPES Required
SENSATION PLAY / SENSORY DEPRIVATION Required
OTHER SESSION ACTIVITIES Required
SPECIALTY SESSION * TOTAL TOILET TRAINING / EXTENDED BONDAGE / CUCKOLDING
PICTURES / VIDEO: Do you consent to pictures and/or videos being taken during the session? These pictures may be utilized for marketing or promotional purposes.

     Session Request submitted successfully. Goddess Khiya will contact you shortly.     

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