Informed consent statement

I am enquiring about voluntarily and at my own risk participating in a session with one or more others where such session may include activities known generally as bondage, domination, and sado-masochism [the Session]. I understand that activities within the Session will be conducted by mutual consent between the participants and may include temporarily and without malice punishment, restraint, smothering or restriction of breathing, torment of body parts, verbal abuse, trampling and other related activities.

1. decide what activities I wish to participate in during the Session and any applicable boundaries to those activities in terms of discomfort and/or outcome;
2. communicate these decisions clearly to other participants before the start of the Session;
3. agree an appropriate safe word or other signal to request an activity stop and/or that I wish to discuss consent, activities, acceptable discomfort, or acceptable outcomes; and
4. signal immediately any unexpected fatigue, shortness of breath, chest discomfort, nausea, pain or discomfort.

If participants in the Session offer any reason for not joining in particular activities, discomfort levels or outcomes then I will adhere to their recommendations and decision, and in good faith we will seek to agree other activities we can jointly participate in. I understand that I can withdraw my consent or discontinue participation in any aspect of the Session at any time without prejudice toward me or penalty beyond fees or tribute for the Session.