Step One: What Do I Want?
My kink role is______________
(Dominant, submissive, top, bottom, switch, slave, Master, pet, owner, girl/boy, Mommy/Daddy, vanilla…)
My level of kink experience is _______________
For me, kink is ________________
(a fantasy, a hobby, a fetish, an orientation, a community, an experiment, a lifestyle…)
I want to play because ________________
(I’m curious, I’m horny, I want catharsis, I want new experiences, I want to please my partner, I just do…)
When I play, I want to feel ____________________
(turned on, scared, safe, powerful, humiliated, sensual, in control, out of control, pushed to my limit, cared for…)
Step Two: What Will We Do?
The one thing I would most like to experience today is __________________
Do I want to engage in dominance/submission, physical play, or both? ___________
Do I want to act out a certain role or scenario? ______________
Do I want to feel/inflict pain? ______________
Do I want to engage in bondage? ____________
Do I want to use toys?____________ If yes, which ones?______________
Do I want to have sexual contact? _____________ If yes, what kind?_______________
Is it okay if I get/give marks? ______________ If yes, where? ________________
Do I want to play in public, with selected people present, or in private? ____________
Step Three: What Will We Not Do?
My safeword is “RED” or __________ (If I cannot speak, my nonverbal safe signal is ___________)
If I use this word, it means play needs to stop RIGHT NOW. Whether I am a top or a bottom, I can use this word at any time for any reason. I will never use this word as a joke or threat. I will never debate or criticize my partner’s use of this word.
My caution word is “YELLOW” or _____________
If I use this word, it means I am getting close to my limit, or I am having a problem. Play needs to pause RIGHT NOW until we both understand and have addressed the problem.
My relevant health concerns are ______________
(STI/STDs, mobility/flexibility limitations, seizure disorder, pregnancy, clotting disorder, prosthetics/implants…)
If I have PTSD/panic attack/phobia/other psychological triggers, they are______________
(certain words, being called certain names, being touched in a certain way, being unable to move…)
If we have sexual contact, we will avoid STI transmission and/or pregnancy by _______________
Is there anything else my partner should know about me, my needs or my desires?____________
Holly Pervocracy, 2012.
www.pervocracy.com
Feel free to copy, share or modify.
Landon, 21 
