Miggins Adult Animal Entertainments

Adult Entertainment Professional Release Form

Revision 7 (01/2009)

SECTION A - CONTACT / IDENTITY INFORMATION

Actor’s Name

Actor’s
Address

Telephone Fax Email

Date of Birth Age Last Current

Birthday Date

Sex Height Weight

Colour of Colour of Colour

eyes hair of skin

Length of Breast size Shoe

penis (men) (women) size

CITES CT355-B / 7 / 06-2005 1

SECTION B – Adult Actor Suitability Checklist

(i) Suitability
# Question YES or NO
1 Are you physically fit?
2 Do you suffer from any disabilities?
3 Do you suffer from any illnesses?
4 Are you taking medication prescribed by a physician or apothecary?
5 Have you ever been sectioned under the mental health act?
6 Have you ever received a diagnosis of mental illness?
7 Are you entering the adult entertainment profession of your own free will?
8 Will you be paid as a result of this work?
9 Are you at liberty to leave the adult entertainment profession at any time?
10 Are you happy to be photographed/videotaped?

(ii) Constraints
# Question YES or NO
1 Would you perform with members of the opposite sex?
2 Would you perform with members of the same sex?
3 Would you perform with animals (of either sex)?
Which kinds of animals? Dogs
A Horses (including donkeys, mules and zebra)
B Cattle
C Sheep
D Goats
E Llamas (including alpaca, guanaco and vicuna)
F Lions
G Tigers
H Bears (all species, including polar)
I Leopards
J Cheetah
K Ocelot
L Lynx
M Camels (dromedary and Bactrian)
N Lizards (including crocodile and alligator)
O Snakes
P Birds (including ostrich and emu)
Q Cetaceans (excluding whales)
R Cetaceans (including whales)
S Invertebrates
4 Would you participate in the following sexual activities?
A Group sex
B Anal Sex
C Cunnilingus
D Fellatio
E Fisting
F Deep throat
G Water sports
H Golden showers
I Brown showers
Miggins AAE CT355-B / 7 / 01-2009 2
J April showers
K Helicoptering
L Dogging
M Dildogging
N Bog-Trotting
O Pony Play
P Bondage
Q Domination
R Sado-Masochism
S Tickling
T Transvestism
U Hiding-the-sausage
V Petanque
W Reverse Polish Notation
Z Thighjobs
Y Scissoring
Z Rimjobs
AA Rimshots
AB Paradiddles
AC Tribbling (with peanuts)
AD Tribbling (without peanuts)
AE Dirty Sanchez
AF Dry humping
AG Loose shunting
AH Deja moo
AJ Mudsharking
AK Skylarking
AL Bashing The Hoon
AM Sleeping
AN Wolfbagging
AO Teabagging
AP Shrooming
AQ Polishing the dragon (without alcohol)
AR Polishing the dragon (with alcohol)
AS Polishing the dragon (with beeswax)
AT Jacking
AU Phlomping
AW Doggy Style (with a dog)
AX Doggy Style (without a dog)
AY Hamstering
AZ Cleveland steamers
BA Wanking
BC Sponking
BD Bog snorkelling
BE Spiderpig
BF Spoon bending
BG Spongmonkey
BH BadgerBadgerBadger
BI Kansas
BJ Mathematics
BK Tony Blair

Miggins AAE CT355-B / 7 / 01-2009 3

(iii) Applicant Statement

QUESTION ANSW ER

1) Why do you want to enter the adult

entertainment industry?

2) How long are you expecting to work in

the adult entertainment industry?

3) What are your favourite sexual

pastimes?

4) What sexual activities will you

absolutely not perform?

5) How do you feel when you are

engaging in sexual activity?

6) When did you start having sexual

activity?

7) How many partners have you

engaged in sexual activity with and
what have you done?

(Answer in detail, use a separate sheet if

necessary)

Miggins AAE CT355-B / 7 / 01-2009 4

SECTION C – Declaration

I/We declare that the information given on this form is true and correct to the best of
my/our knowledge or belief and that I understand that legal penalties may result if any
information I have given is materially incorrect,

In signing this form I absolve Miggins Adult Animal Entertainment PLC from any and
all legal action should injury, trauma (mental or physical), dismemberment,
disembowelling, goring, swelling or death result during any performance in discharge
of my duties as an adult entertainment professional.

Signed Print Name Date

Miggins AAE CT355-B / 7 / 01-2009 5