Scene Negotiation & Limits Checklist

(Compiled from numerous resources)

Before anyone ever "scenes" with someone new, both parties should fill out
this form or one like it, in order to communicate what is wanted and what the
boundaries are. It may seem silly to you, but this is a valuable tool to effective
communication between potential play partners.

GENERAL INFORMATION Date:__________________

Name(s): _______________________________________________________

______________________________________________________________

Relationship Status:

_____ Married, living with spouse

_____ Married, not living with spouse

_____ Divorced, living with significant other

_____ Divorced, not living with significant other

_____ Single, living with significant other

_____ Single, not living with significant other

Do you smoke?

Cigarettes: ___ YES ___ NO <1 pack/day 1-2packs/day 2-3 packs/day

Pot: ___ YES ___ NO

How often do you drink alcohol:
____Never 1-3 times per >>>> ___ year ___ month ___ week ___day

How often do you take drugs:
_____Never _____Only for sickness _____Recreational Use

Past Experience in the Lifestyle:
Cyber/Phone:________________________________________________

Real:_______________________________________________________

Sexual Orientation:
_____Heterosexual _____Bi-curious _____Bi-sexual _____gay

Permanent Record:
Polaroid photo's ___YES ___ NO
If yes, original/copies returned? ___YES ___ NO

Processed photo's ___YES ___ NO
If yes, original/copies returned? ___YES ___ NO

Digital Images ____YES ___NO
If yes, CD with original images returned? ___YES ___NO

Video ___YES ___ NO
If yes, original/copies returned? ___YES ___ NO

Specific Fantasy: ____________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________

Roles:

___ Master ___ Dominant ___ submissive ___ slave

___ Mentor ___ student ___ switch ___ undecided

Location: (Will play at:)

Private home ___YES ___ NO

Hotel ___YES ___ NO

Outdoors ___YES ___ NO

Parties ___YES ___ NO

S/M Clubs ___YES ___ NO

Anywhere ___YES ___ NO

Will Travel if Convenient ___YES ___ NO

Other : _________________

Who can know of your lifestyle activities:

___ No One ___ Family

___ Only those present in the scene ___ People in the Lifestyle

___ Closest Friends ___ Call the Newspapers, I don't care

Obedience:

Submissive will obey promptly ___YES ___ NO

Dominant to use force as part of play? ___YES ___ NO

Submissive verbally resist? ___YES ___ NO

Submissive physically resist? ___YES ___ NO

Submissive will wear collar? ___YES ___ NO

Submissive will address Dominant as Master / Mistress ___YES ___ NO

Safe Words

MERCY = STOP SCENE IN TOTAL

RED = Stop specific action

YELLOW = Approaching pain limit, slow down or ease up, but don't stop.

GREEN = This feels good, go - go - go!!!

Other: ______________________ = ___________________________

Punishment:

___ Pointless ___ Excuse to have fun

___ Penalty for disobedience ___ Part of training

How do you feel about other people participating in your scene:
___No one else ___Threesome ___Foursome ___The More the Merrier

Comments:_______________________________________________________

HEALTH

Physical or Health Limitations: _____________________________________

_______________________________________________________________

Any physical / emotional /phobias/ SM activity limits? __________________

_______________________________________________________________

Do you have any known STD's?

HIV / AIDS

Hepatitis A Hepatitis B Hepatitis C

Herpes - Genital

Other: _________________________________________________________

Do you practice Safe Sex? _________________________________________

Any medical conditions?__________________________________________

_______________________________________________________________

Any surgical implants? (breast, face) _______________________________

Are you taking medication?_______________________________________

Any bone breakage?_____________________________________________

Any chronic conditions?_________________________________________

Are you wearing contact lenses?__________________________________

Any allergies? Please Explain

Bandage tape _________________________________________________

Nonoxynol ___________________________________________________

Rubber ______________________________________________________

Food ________________________________________________________

Sents _______________________________________________________

Oils / Lotions _________________________________________________

Feathers _____________________________________________________

Wool _______________________________________________________

Fur _________________________________________________________

Other? _______________________________________________________

____________________________________________________________

I.C.E. - In Case of Emergency , after 911 is called, notify:

Name: ______________________________________________________

Phone: ______________________________________________________

Relationship: __________________________________________________

-or-

____ Call 911 Only, unless funeral arrangements are necessary.

Pain (General attitude towards pain:)

___Likes ___Accepts ___Neutral ___Dislikes ___Will Not accept

Comments: ________________________________________________

Marks (only below the shoulders)
Is it acceptable to leave any marks after play?

___ No marks
___ Temporary redness or stripes - gone in a few hours
___ Occasional accidental bruises OK
___ Abrasion OK
___ Long lasting stripes and bruises expected - Last 2-5 days
___ Severe marking/souvenir bruises desired - Last 5 or more days
___ Ass look like a road map of Chile
Comments:_____________________________________________________

Time Frame:
______ one session / scene only
______ one day ................Date: ____________
______ one week..............Dates: _______________________
______ other ....................Explain: __________________________________

Limits Checklist

One of the most important first-steps for anyone involved in BDSM is to establish what it is we like and what we don't. If we, ourselves, don't know, our potential play partners won't know either. After we discover our likes/dislikes, it's important to decide what our limits are so that when we're negotiating play or a scene with a new partner, we can adequately say where we feel safe going, where we're not so sure about going and where we absolutely, positively will *not* go.

Rating Scale:

(1) Yes!!! (Pant, drool)

(2) Mmmmmmm, I like this.

(3) Doesn't excite me, but I'll do it if ordered to.

(4) Absolutely not, "safeword" material.

(5) Intriguing, scary, would push my limits.

(6) Embarrassed to admit wanting, please force me.

(7) Never did it, but curious to try

Corporal

S D S D

___ ___ Spanking (hand) ___ ___ Rubber whip

___ ___ Leather paddle ___ ___ Knotted whip

___ ___ Wooden paddle ___ ___ Single Tail

___ ___ Belt / Strap ___ ___ Riding Crop

___ ___ Soft Leather cat ___ ___ Cane (rattan) - English - Marked

___ ___ Leather cat ___ ___ Cane - sensation

___ ___ Braided cat ___ ___ Switch

___ ___ Strapping - Full body beating ___ ___ Plastic Rod

Bondage

S D S D

___ ___ Mental Bondage ___ ___ Spreader Bars

___ ___ Silk Scarves ___ ___ Ceiling/Wall hooks

___ ___ Nylon Rope ___ ___ Cages - Locked

___ ___ Cotton Rope ___ ___ Slings/Swings

___ ___ Braided Rope ___ ___ Stocks/ Pillory

___ ___ Hemp Rope ___ ___ Crosses

___ ___ Rope Harness ___ ___ Suspension (on toes)

___ ___ Chains ___ ___ Suspension (Full)

___ ___ Leather Hood ___ ___ Blindfolds

___ ___ Plastic wrap ___ ___ Outdoor setting

___ ___ Gags ___ ___ Public Setting

___ ___ Leather cuffs ___ ___ Semi-Public Setting

___ ___ Steel Shackles ___ ___ 1-3 hour duration

___ ___ Arm sleeves ___ ___ 3-6 hour duration

___ ___ Straight Jackets ___ ___ Overnight duration

___ ___ Breast Bondage ___ ___ Genital Bondage

___ ___ Japanese Bondage ___ ___ Plastic / Saran Wrap

Torture

S D S D

___ ___ Blindfolds ___ ___ Weights

___ ___ Hoods ___ ___ Cock rings

___ ___ Ear Plugs ___ ___ Ball stretchers

___ ___ Tickling ___ ___ Water torture

___ ___ Feather/ Fur ___ ___ Ice

___ ___ Sexual Teasing ___ ___ Oils, lotions, spice

___ ___ Sexual Denial ___ ___ Hot wax

___ ___ Chastity Belt ___ ___ Fire & Ice

___ ___ Pinching ___ ___ Needles

___ ___ Hair Pulling ___ ___ Cuttings

___ ___ Nipple clips / clamps ___ ___ Abrasions

___ ___ Nipple Weights ___ ___ Genital Whipping

___ ___ Ball stretching - weights ___ ___ Electrical

___ ___ Breast Whipping ___ ___ Violet Wand

___ ___ Knife Play - no cuttings ___ ___ Tens Unit

___ ___ Catherization ___ ___ Cattle Prod

___ ___ Clothes Pins / Zippers ___ ___ Sensory Deprivation

___ ___ Nose Torture ___ ___ Paddles - Leather

___ ___ Japanese Pony - Riding the horse - (crothch torture) ___ ___ Paddles - Wooden

___ ___ Labia Clit Torture - Clamps, clothes pins ___ ___ Tickling

___ ___ Wartenburg Wheel - Pinwheel ___ ___ Cupping

___ ___ Vampire Gloves

Sex

S D S D

___ ___ Self Masturbation ___ ___ Vaginal fisting

___ ___ Assisted Masturbation
(Digital Sex) ___ ___ Anal fisting

___ ___ Vaginal sex ___ ___ Fantasy rape

___ ___ Oral sex (Fellatio)
Giving Head ___ ___ Directed bisexuality

___ ___ Oral sex (cunnilingus)
Licking pussy ___ ___ Threesomes

___ ___ Vibrator / dildo ___ ___ Group

___ ___ Strap on ___ ___ Enema

___ ___ Anal sex ___ ___ Golden showers

___ ___ Multiple penetration ___ ___ Kissing

___ ___ Ass Play (Anilingus) ___ ___ Double Penetration

___ ___ Serving orally other Doms (supervised) ___ ___ Pearl Showers - Cum on Face

Serving orally other Doms (unsupervised) ___ ___ Swallowing Semen

Humiliation

S D S D

___ ___ Foot kissing ___ ___ Cross Dressing

___ ___ Boot worship ___ ___ Secret sex in Public

___ ___ Kneeling ___ ___ Public display

___ ___ Crawling on leash ___ ___ Public sex

___ ___ Dirty words ___ ___ Public whipping

___ ___ Verbal abuse ___ ___ Bondage under clothes in public

___ ___ Public embarrassment ___ ___ Chamber Pot Use

___ ___ Lectures for misbehavior ___ ___ Cock Ring

___ ___ Face slapping ___ ___ Cock Worship

___ ___ Diapers ___ ___ Forced Nudity- private

___ ___ Public Shaving ___ ___ Forced Nudity- public

___ ___ Forced homosexuality ___ ___ Serving as furniture

___ ___ Forced Heterosexuality ___ ___ Serving as ashtray

___ ___ Head Shaving ___ ___ Serving as toilet

___ ___ Anal Plugs - Small ___ ___ Golden Showers

___ ___ Anal Plugs - Medium ___ ___ Bathroom Control - Permission

___ ___ Anal Plugs - Large ___ ___ Swallowing Urine

___ ___ Anal Plugs - in public under
clothers ___ ___ Enema - cleansing

___ ___ Strap on Dildos - Sucking on ___ ___ Enema - Retention Training

___ ___ Strap on Dildos - penetrated by

___ ___ Strap on Dildos - Wearing

Exhibitionism

S D S D

___ ___ Public scening in a club ___ ___ Sex in Public

___ ___ Cross Dressing ___ ___ Skinny Dipping

___ ___ Slutty clothing in public ___ ___ Serving as Art

___ ___ In front of friends ___ ___ Forced Nudity

___ ___ In front of strangers ___ ___ Forced Public Service

Fetish

S D S D

___ ___ Smoking ___ ___ Leather

___ ___ High heel wearing ___ ___ Rubber / Latex

___ ___ Uniforms ___ ___ PVC

___ ___ Slutty clothin - public ___ ___ Tattoos

___ ___ Hair Pulling ___ ___ Piercings

Other:

___ ___ Biting / Being Biten ___ ___ Cross Dressing

___ ___ Collar worn in private ___ ___ Blood Play / cutting

___ ___ Collar worn in public ___ ___ Forced Exercise

___ ___ Contract Slave ___ ___ Eye Contact Restrictions

___ ___ Following Orders ___ ___ Gor Slave Positions - Training

___ ___ Wearing Symbolic Jewelry ___ ___ Name Change

___ ___ Personality Modification ___ ___ Rituals

___ ___ Standing in Corner-punishment ___ ___ TPE-Total Power Exchange

___ ___ Harems - Serving with others ___ ___ Wrestling

Role Playing and Dress

S D S D

___ ___ Leather ___ ___ French Maid

___ ___ Rubber / Latex ___ ___ Barbarian

___ ___ PVC ___ ___ Nurse / Medical

___ ___ Chastity Belt/Devices ___ ___ Priest / Nun

___ ___ Lingerie ___ ___ Kidnap victim

___ ___ Corsets ___ ___ Hooker

___ ___ Boots ___ ___ Knight

___ ___ High heels ___ ___ Prisoner (convict)

___ ___ Temporary Tattoos ___ ___ Prisoner (war)

___ ___ Ponygirl/Ponyboy

___ ___ ___ ___ Slave

___ ___ ___ ___ Slut

___ ___ ___ ___ Geisha

___ ___

___ ___ Butler

___ ___ Age Play - Infant ___ ___ Chauffer

___ ___ Age Play - child ___ ___ Bodyguard

___ ___ Age Play - Catholic School Girl

Other: ______________________________________________________

________________________________________________________

Submissive Service

S D S D

___ ___ House Cleaning ___ ___ Kitchen - Cooking & Cleaning

___ ___ Chauffering ___ ___ Grocery Shopping

___ ___ Having Clothes chosen for you ___ ___ Clothes Washing

___ ___ Having Food chosen for you ___ ___ Ironing

___ ___ Speech Restriction ___ ___ Yard Maintenance

___ ___ Hair Style chosen for you ___ ___ Erotic Dance

___ ___ Hair Color chosen for you ___ ___ Forced weight gain

___ ___ Serving as Art ___ ___ Forced weight loss

___ ___ Wearing symbolic jewelry ___ ___

___ ___ Given away to another Dom - Temp

___ ___ Given away to another Dom - Permanant

Body Modifications / Symbols of Ownership:

* NOTE: Body Modifications are permanant. It is understood that any of the below would be thoroughly negotiated, unless you put down #6 which indicates that you want it done without negotiations.

S D Comments

___ ___ Slave Marking ______________________________________

___ ___ Tattooing ______________________________________

___ ___ Piercing - Nipples ______________________________________

___ ___ Piercing - Genitals ______________________________________

___ ___ Branding ______________________________________

___ ___ Cuttings ______________________________________

Signatures of both/all participants:

Signed: _____________________________________ Date __________

Print Name __________________________________

Signed: _____________________________________ Date __________

Print Name _________________________________

(Compiled from numerous sources)