Consensual Agreement for Play Scene (Long Form)

Tags

BDSM, Bondage, Bottom (BDSM), Conditions and Diseases, D/s, Dominance, Health, Humiliation, Mature Content, Sadomasochism, Sexually Graphic, Story of O, Submission

CONSENSUAL NEGOTIATION FOR SCENE PLAY (LONG FORM)

Recommended for novices, please use the back of the form if you need additional space.

1. PEOPLE:

Who (only) will take part?________________________________________________

Who (only) will watch?___________________________________________________

Will any permanent record (photographs, audiotapes, videotapes, etc.) be made of the session? Yes_____ No_____

Explanation__________________________________________________________

2. ROLES:

Who will be dominant?_________________________________________________

Who will be submissive?_________________________________________________

Type of scene:

[] Master/slave

[] Mistress/slave

[] Captive

[] Age play

[] Servant, butler, etc.

[] Cross-dressing/gender play

[] Animal play

[] Other_________________________

Any chance of switching roles? Yes_____ No_____

Explanation:___________________________________________________________

Will the submissive promptly obey? Yes_____ No_____

Explanation:___________________________________________________________

May the dominant “overpower” or “force” the submissive? Yes_____ No____ Explanation:___________________________________________________________

May the submissive verbally resist? Yes_____ No_____

Explanation:___________________________________________________________

May the submissive physically resist? Yes_____ No_____

Explanation:___________________________________________________________

Does resistance equal a “strong yellow”? Yes_____ No_____

Explanation:___________________________________________________________

May the submissive try to “turn the tables:? Yes_____ No_____

Explanation:___________________________________________________________

Does the submissive agree to wear a collar? Yes_____ No_____

Explanation:___________________________________________________________

The submissive agrees to address the dominant by the following title(s): ____________________________________________________________________

3. PLACE:

Location:_____________________________________________________________

Who will ensure privacy?_________________________________________________

4. TIME:

Begin at:__________ Length:________________________

Beginning signal:_______________________________________________________

Ending signal:_________________________________________________________

Who will keep track of time?______________________________________________

5. OOPS:

Does everybody involved understand that there is some risk of accident, miscommunication, misperception, and/or unintentional injury?

Yes___ No___

Does everybody involved agree to discuss any mishaps in a constructive and non-blaming manner?

Yes_____ No_____

6. LIMITS & SAFETY:

Submissive’s limits:

Any problems with the submissive’s:

• Heart: Yes______No_____

Explanation:___________________________________________________________

• Lungs: Yes______No_____

Explanation:___________________________________________________________

• Neck/back/bones/joints: Yes______No_____

Explanation:___________________________________________________________

• Kidneys: Yes______No_____

Explanation:___________________________________________________________

• Liver: Yes______No_____

Explanation:___________________________________________________________

• Nervous system/mental: Yes______No_____

Explanation:___________________________________________________________

Is the submissive wearing contact lenses? Yes_____ No_____

Does the submissive suffer from carpal tunnel syndrome or any related problems?

Yes_____ No_____

Does the submissive have a history of:

• Seizures: Yes______No_____

Explanation:___________________________________________________________

• Dizzy spells: Yes______No_____

Explanation:___________________________________________________________

• Diabetes: Yes______No_____

Explanation:___________________________________________________________

• High or low blood pressure: Yes______No_____

Explanation:___________________________________________________________

• Fainting: Yes______No_____

Explanation:___________________________________________________________

• Asthma: Yes______No_____

Explanation:___________________________________________________________

• Hyperventilation attacks: Yes______No_____

Explanation:___________________________________________________________

Describe any phobias:__________________________________________________

Submissive’s other medical conditions:_____________________________________

Any surgical implants (breast, face, etc.)? Yes_____ No_____

Explanation:__________________________________________________________

Is the submissive taking aspirin? Yes_____ No_____

Is the submissive taking ibuprofen, Aleve, or other non-steroidal, anti-inflammatory drugs? Yes_____ No_____

Is the submissive taking antihistamines? Yes_____ No_____

Other medications the submissive is taking:_________________________________

Is the submissive allergic to:

• Bandage tape: Yes______No_____

Explanation:___________________________________________________________

• Nonoxynol-9: Yes______No_____

Explanation:___________________________________________________________

Other allergies:_________________________________________________________

In case of emergency notify:______________________________________________

Dominant’s Limits:

Any problems with the Dominant’s:

• Heart: Yes______No_____

Explanation:___________________________________________________________

• Lungs: Yes______No_____

Explanation:___________________________________________________________

• Neck/back/bones/joints: Yes______No_____

Explanation:___________________________________________________________

• Kidneys: Yes______No_____

Explanation:___________________________________________________________

• Liver: Yes______No_____

Explanation:___________________________________________________________

• Nervous system/mental: Yes______No_____

Explanation:___________________________________________________________

Dominant’s other medical conditions:______________________________________

Medications the dominant is taking:_______________________________________

In case of emergency notify:______________________________________________

Is the dominant currently certified in First Aid and CPR:

Yes______No_____

Safety gear on hand:

• Paramedic scissors: yes/no
• Flashlight: yes/no
• First aid kit: yes/no
• Blackout light: yes/no
• Fire extinguisher: yes/no

Will the play be in an isolated area such as a farmhouse?

Yes_____ No_____

Explanation:___________________________________________________________

If yes, what will ensure the submissive’s safety if the dominant becomes unconscious?

• No bondage to chair/bed/etc.: yes/no
• No gag: yes/no
• Silent alarm: yes/no
• Third person present: yes/no
• Telephone/radio/panic button within submissive’s reach: yes/no
• Other:________________________________________________________________

7. SEX

Does any participant believe they might have a sexually transmitted disease?

Yes_____ No_____

Explanation:___________________________________________________________

Does any participant believe they might have herpes? Yes_____ No_____

Explanation:___________________________________________________________

Have participants been tested for HIV? Yes_____ No_____

Has any participant tested positive? Yes_____ No_____

Explanation:___________________________________________________________

Circle which of the following sexual acts are acceptable:

1. Masturbation:

• Dominant to submissive
• submissive to Dominant
• self-masturbation by submissive
• self-masturbation by Dominant

2.  Fellatio:

• Dominant to submissive
• submissive to Dominant

3.  Cunnilingus:

• Dominant to submissive
• submissive to Dominant

4.  Analingus:

• Dominant to submissive
• submissive to Dominant

5.  Vaginal fisting:

• Dominant to submissive
• submissive to Dominant

6.  Anal fisting:

• Dominant to submissive
• submissive to Dominant

7.  Vaginal intercourse:

• Dominant to submissive
• submissive to Dominant

8.  Anal intercourse:

• Dominant to submissive
• submissive to Dominant

Is swallowing semen acceptable? Yes_____ No_____

Is any participant menstruating? Yes_____ No_____

Will sex toys such as vibrators, dildos, butt plugs, etc. be used? Yes/No

If yes, describe:_______________________________________________________

Which of the above activities will involve birth control pills, diaphragms, spermicidal suppositories, lubricants containing nonoxynol-9, or contraceptive foams/suppositories/gels?__________________________________

Which of the above activities will involve condoms, gloves, dental dams, and/or other barriers?____________________________________________________

8. INTOXICANTS (Not suggested for Scene Play)

The Dominant can use (only) the following intoxicants during the session: ___________________________________________________________________

Acceptable quantity:____________________________________________________

The submissive can use (only) the following intoxicants during the session: ____________________________________________________________________

Acceptable quantity:____________________________________________________

9. BONDAGE

The submissive agrees to allow (only) the following types of bondage:

• hands in front: yes/no
• hands behind back: yes/no
• ankles: yes/no
• knees: yes/no
• elbows: yes/no
• wrists to ankles (hog-tie): yes/no
• spreader bars: yes/no
• tied to chair: yes/no
• tied to bed: yes/no
• use of blindfold: yes/no
• use of gag: yes/no
• use of hood: yes/no
• use of rope: yes/no
• use of tape: yes/no
• use of leather cuffs: yes/no
• use of handcuffs/metal restraints: yes/no
• suspension: yes/no
• mummification with plastic wrap, body bag, or similar technique: yes/no

Any past bad experiences by either person with bondage, gags, blindfolds, and/or hoods? Yes_____ No_____

Explanation:___________________________________________________________

10. PAIN

Submissive’s general attitude toward receiving pain:

_____likes _____accepts _____neutral _____dislikes _____will not accept

Quantity of pain the submissive wants to receive:

_____none _____small _____average _____large

Explanation:___________________________________________________________

Dominant’s general attitude toward giving pain:

____likes ____will give ____neutral ____dislikes ____will not give

Quantity of pain the Dominant wants to give:

_____none _____small _____average _____large

Explanation:___________________________________________________________

Will the “now” technique be used? Yes_____ No_____

Explanation:___________________________________________________________

Will the “nod” technique be used? Yes_____ No_____

Explanation:___________________________________________________________

Will the “one to ten” technique be used? Yes_____ No_____

Explanation:___________________________________________________________

The following types of pain are acceptable:

• spanking: yes/no
• paddling: yes/no
• flogging: yes/no
• caning: yes/no
• face slaps: yes/no
• biting: yes/no
• nipple clamps: yes/no
• genital clamps: yes/no
• clamps elsewhere: yes/no
• locations:_________________
• hot creams: yes/no
• ice: yes/no
• hot wax: yes/no
• tickling: yes/no
• Other types/methods of pain:_____________________________________________

Additional remarks:_____________________________________________________

11. MARKS

Is it acceptable to the submissive if the play leaves marks?

Yes___ No___

• Visible while wearing street clothes? Yes____ No____
• Visible while wearing a bathing suit? Yes____ No____

Is it acceptable to the submissive if the play draws small amounts of blood?

Yes____ No____

Explanation:___________________________________________________________

How easy or difficult has it been to mark the submissive in the past? _____________________________________________________________________

12. EROTIC HUMILIATION

The submissive agrees to accept being referred to by the following terms: _____________________________________________________________________

The submissive agrees to the following forms of erotic humiliation:

• “verbal abuse”: yes/no
• enemas: yes/no
• face slapping: yes/no
• forced exhibitionism: yes/no
• spitting: yes/no
• water sports: yes/no
• scat games: yes/no
• Other:______________________________________________________________

Any prior really good or really bad experiences in these areas?________________________________________________________________________________

13. SAFEWORDS

Safeword # 1 and its meaning:____________________________________________

Safeword # 2 and its meaning:____________________________________________

Safeword # 3 and its meaning:____________________________________________

Non-verbal safewords(signs) and their meaning:____________________________________

Will the “two squeezes” technique be used? Yes____ No____

Will the “extended hand” technique be used? Yes____ No____

14. OPPORTUNITIES/SPECIAL SKILLS

Anything either party would especially like to try or explore?

Yes____ No___

Explanation:___________________________________________________________

15. FOLLOW-UP

(Please include a note about who will initiate contacts.)

After the session:_______________________________________________________

The next day:__________________________________________________________

A week later:__________________________________________________________

In the event of a crisis:__________________________________________________

16. ANYTHING ELSE?

No____ Yes____

Explanation:__________________________________________

What will become of this form after the session?_________________________

POST-SESSION NOTES AND FEEDBACK

Dominant Overall feeling about the session on a scale of one-to-ten (ten tops)______

Best part of the session and on a scale of one-to-ten how good was it? _____________________________________________________________________

Worst part of the session and on a scale of one-to-ten how bad was it? ____________________________________________________________________

Other comments:_______________________________________________________

Submissive Overall feeling about the session on a scale of one-to-ten (ten tops)_______

Best part of the session and on a scale of one-to-ten how good was it? ____________________________________________________________________

Worst part of the session and on a scale of one-to-ten how bad was it? ____________________________________________________________________

Other comments:_______________________________________________________

Copyright © 1998 Jay Wiseman

A big thanks to Jay Wiseman for his inumerable contributions to BDSM Practice and Safety  !

Please visit Jay’s page Submissive Women Kvetch