Roles & scene type
Top (name / handle):
Bottom (name / handle):
Scene type:
Switching allowed mid-scene: ☐ Yes ☐ No
Activities
Tick the activities in scope for this scene.
- ☐ Bondage
- ☐ Suspension
- ☐ Impact Play
- ☐ Fire Play
- ☐ Needle Play
- ☐ Wax Play
- ☐ Electrical Play
- ☐ Sensation Play
- ☐ Humiliation & Verbal
- ☐ Sex Acts
- ☐ D/s Roleplay
- ☐ Service & Protocol
- ☐ Primal & Pet Play
- ☐ Edge Play
- ☐ Other (specify)
Place & time
Location:
Who ensures privacy?:
Begin at:
Length:
Beginning signal:
Ending signal:
Who keeps track of time?:
Limits
Hard limits (non-negotiable): Soft limits (under what conditions): Preferences (what you'd like, within range):
Safewords
Traffic-light system (red / yellow / green): ☐ Yes ☐ No
Two-squeezes nonverbal check-in: ☐ Yes ☐ No
Safeword 1 / Meaning:
Safeword 2 / Meaning:
Non-verbal signals & their meaning:
Health & medical
Current conditions (cardiac, lungs, joints, neuro, etc.): Medications & intoxicants in the last 24h: Allergies & sensitivities: In an emergency, contact:
Phobias / known triggers:
Scene safety
Top is current on First Aid / CPR: ☐ Yes ☐ No
Paramedic scissors on hand: ☐ Yes ☐ No
First aid kit on hand: ☐ Yes ☐ No
Fire extinguisher on hand: ☐ Yes ☐ No
Flashlight on hand: ☐ Yes ☐ No
Play takes place in an isolated location: ☐ Yes ☐ No
If isolated: how is bottom's safety ensured if top loses consciousness?:
Marks
Marks are acceptable: ☐ Yes ☐ No
OK when not visible under street clothes: ☐ Yes ☐ No
OK when not visible in swimwear: ☐ Yes ☐ No
Drawing small amounts of blood is OK: ☐ Yes ☐ No
Aftercare
Aftercare gets negotiated before you need it. Pick what you typically want.
- ☐ Holding
- ☐ Gentle touch
- ☐ No touch
- ☐ Verbal reassurance
- ☐ Alone time
- ☐ Calm presence
- ☐ Water
- ☐ Snacks
- ☐ Shower
Aftercare notes (timing, specifics):
Follow-up
Coming-down period right after: ☐ Yes ☐ No
Next-day check-in: ☐ Yes ☐ No
Week-later follow-up: ☐ Yes ☐ No
Crisis protocol (who to call if it goes badly):