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Yes_____ No_____ Has any participant tested positive?Yes_____ No_____ Explanation:___________________________________________________________ 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:____________________________________________________ Anything either party would especially like to try or explore?

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Yes_____ No_____ Explanation:___________________________________________________________ Will the “nod” technique be used?

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

Yes____ No___ Explanation:___________________________________________________________ (Please include a note about who will initiate contacts.) Daily:_______________________________________________________ Weekly:__________________________________________________________ Monthly:__________________________________________________________ In the event of a crisis:__________________________________________________ No____ Yes____ Explanation:__________________________________________ What will become of this form after the termination of the relationship?

_________________________ How will the Dominant keep record and track the progress of the relationship? _____________________________________________________________________ Does the Dominant agree to maintain a safe environment for communication and growth between both parties; including but not limited to meeting to discuss concerns, accepting inquiries from the submissive regarding expectations/duties, and provide physical, mental , and emotional care and mutual respect?

Yes_____ No_____ Explanation:___________________________________________________________ Does resistance equal a “strong yellow”?

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

I will strive to maintain discipline, consistency, and creativity in our lives.

Remember the time difference between the Philippines and your location!

Yes_____ No_____ Does the submissive take antihistamines?

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