Posted by: LadyMuse | November 17, 2006

Submissive Checklist

Submissive checklist

For each item, you need to provide two answers:
* For experience, write YES or NO next to each item to indicate if you have ever DONE that activity. Mark N/A if it does not apply to your gender.
* For willingness, indicate for each item how you feel about DOING that activity by rating it on a scale of NO or 0 to 5.
o “?” means you don’t understand what the item is attempting to describe.
o NO means you will NOT do that item under any circumstances (a hard limit).
0 (zero) indicates you have utterly no desire to do that activity and don’t like doing it (in fact, may loath it) and would ordinarily object to doing it, but you would permit the Dominant to do it if it they really wanted it. (sometimes called a “soft limit”).

1 means you don’t want to do or like to do this activity, but wouldn’t object if it was asked of you.

2 means you are willing to do this activity, but it has no special appeal for you.

3 means you usually like doing this activity, at least on an irregular/ occasional basis.

4 means you like doing this activity, and would like to experience it on a regular basis.

5 means the activity is a wild turn-on for you, and you would like it as often as possible.

* Mark with an asterisk (*) those items which you are willing to do only with your current sex partner(s), but not with casual play-partners.

* Note any additional information or nuances which might be important for your Dom to know in the margin to the right. For example under diapers you might wish to distinguish between “wetting” and “soiling”.

There is intentionally some overlap between categories. Unless otherwise stated, the Sub is the receiver/target of the activity.
Experience, Willingness Notes & Nuances yes/no, NO or 0-5
Abrasion:
Age play:
Anal sex:
Anal plugs (small)
Anal plugs (large):
Anal plug (public, under clothes):
Animal roles:
Arm & leg sleeves (arm binders):
Aromas:
Asphyxiation:
Auctioned for charity:
Ball stretching:
Bathroom use control:
Bestiality:
Beating (soft):
Beating (hard):
Ben wa Balls:
Blindfolds:
Being serviced (sexual) :
Being bitten:
Breast/chest bondage:
Breath control:
Branding:
Boot worship:
Bondage (light):
Bondage (heavy):
Bondage (multi-day):
Bondage (public, under clothing):
Breast whipping:
Brown showers (scat):
Cages (locked inside of):
Caning:
Castration fantasy:
Catheterization:
Cattle prod (electrical toy):
Cells/Closets (locked inside of):
Chains:
Chamber-pot use:
Chastity belts:
Chauffeuring:
Choking:
Chores (domestic service):
Clothespins:
Cock rings/straps:
Cock worship:
Collars (worn in private):
Collars (worn in public):
Competitions (with other Subs):
Corsets (wearing casually):
Corsets (trained waist reduction):
Cuffs (leather):
Cuffs (metal):
Cutting:
Diapers (wearing):
Diapers (wetting):
Diapers (soiling):
Dilation:
Dildoes:
Double penetration:
Electricity:
Enemas (for cleansing):
Enemas (retention/punishment):
Enforced chastity:
Erotic dance (for audience):
Examinations (physical):
Exercise (forced/required):
Exhibitionism (friends):
Exhibitionism (strangers):
Eye contact restrictions:
Face slapping:
Fantasy abandonment:
Fantasy rape:
Fantasy gang-rape:
Fantasy gang-bang:
Fear (being scared):
Fisting (anal):
Fisting (vaginal):
Flame play:
Floggers:
Following orders:
Foot worship:
Forced bedwetting:
Forced dressing:
Forced eating:
Forced homosexuality:
Forced heterosexuality:
Forced masturbation:
Forced nudity (private):
Forced nudity (around others):
Forced servitude:
Forced smoking:
Full head hoods:
Gags (cloth):
Gags (inflatable):
Gags (phallic):
Gags (rubber):
Gags (tape):
Gas masks:
Gates of Hell (male):
Genital sex:
Given away to another Dom (temp):
Given away to another Dom (perm):
Golden showers:
Gun play:
Hairbrush spankings:
Hair pulling:
Hand jobs (giving):
Hand jobs (receiving):
Harems (serving w/other subs):
Harnessing (leather):
Harnessing (rope):
Having food chosen for you:
Having clothing chosen for you:
Head (give fellatio/cunnilingus):
Head (rcv fellatio/cunnilingus):
High heel wearing:
High heel worship:
Homage with tongue (non-sexual):
Hoods:
Hot oils (on genitals):
Hot waxing:
Housework (doing):
Human puppy dog:
Humiliation (private):
Humiliation (public):
Hypnotism:
Ice cubes:
Immobilization:
Infantilism:
Initiation rites:
Injections:
Intricate (Japanese) rope bondage:
Interrogations:
Kidnapping:
Kneeling:
Knife play:
Leather clothing:
Leather restraints:
Lectures for misbehavior:
Licking (non-sexual):
Lingerie (wearing):
Manacles & Irons:
Manicures (giving):
Massage (giving):
Massage (receiving)
Medical scenes:
Modeling for erotic photos:
Mouth bits:
Mummification:
Nipple clamps:
Nipple rings (piercings):
Nipple weights :
Oral/anal play (rimming):
Over-the-knee spanking:
Orgasm denial:
Orgasm control:
Outdoor scenes:
Outdoor sex:
Pain (severe):
Pain (mild):
Persona training (in scene):
Personality modification (RL):
Phone sex (serving Dom):
Piercing (temporary, play-pierce):
Piercing (permanent):
Plastic surgery:
Prison scenes:
Prostitution (public pretense):
Prostitution (actual):
Pony slave:
Public exposure:
Punishment Scene:
Pussy/cock whipping:
Riding crop :
Riding the “horse” (crotch torture):
Rituals:
Religious scenes:
Restrictive rules on behavior:
Rubber/latex clothing:
Rope body harness:
Saran wrapping:
Scratching – getting:
Scratching – giving:
Sensory deprivation:
Serving:
Serving as art:
Serving as ashtray:
Serving as furniture:
Serving as a maid:
Serving as toilet (urine):
Serving as toilet (feces):
Serving as waitress/waiter:
Serving orally (sexual):
Serving other Doms (supervised):
Serving other Doms (unsupervised):
Sexual deprivation (short term):
Sexual deprivation (long term):
Shaving (body hair):
Shaving (head hair):
Skinny-dipping:
Sleep deprivation:
Sleepsacks:
Slutty clothing (private):
Slutty clothing (public):
Spandex clothing:
Spanking:
Speech restrictions (when, what):
Speculums (Anal) :
Speculums (vaginal) :
Spitting:
Spreader bars:
Standing in corner:
Kneeling in corner:
Stocks:
Straight jackets:
Strap-on-dildos (sucking on):
Strap-on-dildos (penetrated by):
Strap-on-dildos (wearing):
Strapping (full body beating):
Suspension (upright) :
Suspension (inverted):
Suspension (horizontal):
Supplying new partners for Dom:
Swallowing feces:
Swallowing semen:
Swallowing urine:
Swapping (with one other couple):
Swinging (multiple couples):
Tampon Training (in ass):
Tattooing:
Teasing:
TENS Unit (electrical toy):
Thumbcuffs (metal):
Tickling:
Triple penetration:
Urethral Sounds (metal rods):
Uniforms:
Including others:
Vaginal dildo:
Verbal humiliation:
Vibrator on genitals:
Vibrator inserted vaginally:
Vibrator inserted rectally:
Violet Wand (electricial toy):
Voyeurism (watching others):
Voyeurism (your Dom w/others):
Video (watching others):
Video (recordings of you):
Water torture:
Waxing (hair removal):
Wearing symbolic jewelery:
Weight gain (forced):
Weight loss (forced):
Whipping:
Wooden paddles:
Wrestling:

Scene Negotiation Form
Answer the questions honestly and openly, for this will help the Dominant in making the submissive’s experience more enjoyable Submissive’s Medical Information
Does the submissive have any of the following problems:
(Please explain any yes answers)
Heart                                      No Yes
Liver                                       No Yes
Lungs                                     No Yes
Neck                                       No Yes
Back                                       No Yes
Bones                                     No Yes
Joints                                     No Yes
Kidneys                                  No Yes
Nervous System                     No Yes
Mental                                    No Yes
Drug Metering Pumps             No Yes
Surgical Implants                    No Yes
Contact lenses                       No Yes
Implanted pace maker            No Yes
Explaination of Any Yes Answers From Above:
Does the submissive have a history of:
(Please explain any yes answers)
Seizures                                  No Yes
Dizzy Spells                             No Yes
Diabetes                                 No Yes
Hyperglycemia                        No Yes
Seizures Disorders                 No Yes
Brain Wave Abnormality         No Yes
High Blood Pressure               No Yes
Fainting                                   No Yes
Asthma                                   No Yes
Heart Rhythm Oddities            No Yes
Hyperventilation                      No Yes
Explaination:
What phobias does the submissive have?
Drugs
Aspirin                                       No Yes
Ibuprofen                                   No Yes
Motrin                                        No Yes
Anti-inflammatory drugs              No Yes
Antihistamines                           No Yes
Prescription Meds                     No Yes
Social Drugs                              No Yes
Alcohol (beer, wine etc.)            No Yes
Other medications submissive is taking:
Allergies
Bandage tape                          No Yes
Nonoxynol-9                            No Yes
Lubricants                               No Yes
Latex                                       No Yes
Other allergies:

Submissive’s Emergency Information
In case of emergency notify:
Name:
Phone Number:
(You might want to choose someone who knows about your lifestyle choices)

Dominant’s Medical Information
Does the Dominant have any of the following problems:
(Please explain any yes answers)
Heart                                   No Yes
Liver                                    No Yes
Lungs                                  No Yes
Neck                                   No Yes
Back                                     No Yes
Bones                                   No Yes
Joints                                    No Yes
Kidneys                                 No Yes
Nervous System                    No Yes
Mental                                   No Yes
Drug Metering Pumps            No Yes
Surgical Implants                   No Yes
Contact lenses                      No Yes
Implanted pace maker           No Yes

Explain
Does the Dominant have a history of:
(Please explain any yes answers)
Seizures                                  No Yes
Dizzy Spells                             No Yes
Diabetes                                 No Yes
Hyperglycemia                        No Yes
Seizures Disorders                 No Yes
Brain Wave Abnormality         No Yes
High Blood Pressure               No Yes
Fainting                                   No Yes
Asthma                                    No Yes
Heart Rhythm Oddities             No Yes
Hyperventilation                       No Yes
Explain:
Drugs
Aspirin                                        No Yes
Ibuprofen                                    No Yes
Motrin                                         No Yes
Anti-inflammatory drugs              No Yes
Antihistamines                           No Yes
Prescription Meds                      No Yes
Social Drugs                              No Yes
Alcohol (beer, wine etc.)            No Yes
Other medications dominant is taking:
Allergies
Bandage tape                           No Yes
Nonoxynol-9                              No Yes
Lubricants                                 No Yes
Latex                                         No Yes
Other allergies:

Dominant’s Emergency Information
In case of emergency notify:
Name:
Phone Number:
Next of Kin:
(You might want to choose someone who knows about your lifestyle choices)
Safety Issues:
Certified in 1st Aid/CPR               No Yes
Safety gear on hand                    No Yes
Paramedic scissors                     No Yes
Fire extinguisher                         No Yes
First Aid Kit                                 No Yes
Blackout lights                            No Yes
Flashlight                                    No Yes

Sexual Issues:
The Dominant
Is the Dominant…                                      male female
Is the Dominant Transsexual?                   No Yes
Dominant have a yeast infection?             No Yes
Dominant have herpes?                             No Yes
Dominant have any STD’s?                       No Yes
Dominant have hepatitis?                          No Yes
Dominant been tested for HIV?                  No Yes
If yes, was the test positive?                     No Yes

The submissive
Is the submissive…                                    male female
Is the submissive transsexual?                  No Yes
Submissive have a yeast infection?          No Yes
submissive have herpes?                         No Yes
submissive have any STD’s?                    No Yes
Does the submissive have hepatitis?       No Yes
Submissive been tested for HIV?             No Yes
If yes was the test positive?                    No Yes

Sexual Acts:
Which of the following sexual acts are acceptable:
Dom to sub
Masturbation             Yes No
Fellatio                      Yes No
Cunnilingus                Yes No
Rimming                    Yes No
Anal Fisting               Yes No
Vaginal Fisting          Yes No
Vaginal intercourse   Yes No
Anal intercourse        Yes No
Swallowing semen     Yes No

Sub To Dom
Masturbation              Yes No
Fellatio                      Yes No
Cunnilingus                Yes No
Rimming                    Yes No
Anal Fisting               Yes No
Vaginal Fisting           Yes No
Vaginal intercourse    Yes No
Anal intercourse         Yes No
Swallowing semen      Yes No

Toys
Will any sex toys such as vibrators, dildos, butt plugs, ben wa balls, etc be used?        Yes No
Describe:
Which of the above activities will involve birth control pills, diaphragms, spermicidal suppositories, lubricants containing nonoxynol-9 or contraceptive foam/suppositoried/gel?
Which of the above activities will involve condoms, gloves, dental dams and/or other barriers?
Intoxicants — No Intoxicants can be used by either party in the scene

Bondage
The submissive agrees to allow (only) the following types of bondage:
Hands in front                  Yes No
Hands behind                  Yes No
Ankles                             Yes No
Knees                             Yes No
Breasts                           Yes No
Elbows                            Yes No
Wrists to ankles              Yes No
Spreader bars                Yes No
Tied to Chair                  Yes No
Tied to bed                    Yes No
Use of blindfold              Yes No
Use of gag                     Yes No
Use of hood                   Yes No
Use of rope                    Yes No
Use of chains                Yes No
Use of handcuffs           Yes No
Use of tape                   Yes No
Use of leather cuffs       Yes No
Suspension                   Yes No
Acceptable degree of immobility/helplessness:

Limited Moderate Extreme Pain
submissive’s general attitude about receiving pain:
Likes Accepts Neutral Dislikes Will not accept Quantity of pain submissive wants to receive:

None Small Average Large
Dominant’s general attitude about giving pain:
Likes Accepts Neutral Dislikes Will not accept Quantity of pain dominants wants to give:

None Small Average Large
The following types of pain are acceptable:
Spanking                          Yes No
Paddling                           Yes No
Whipping                          Yes No
Caning                              Yes No
Face slaps                        Yes No
Biting                                 Yes No
Nipple clamps                    Yes No
Genital clamps                  Yes No
Hot Creams                      Yes No
Ice                                    Yes No
Clamps elsewhere            Yes No   Locations:
Hot Wax                           Yes No

Other types/methods of pain:
Additional remarks:
Marks Acceptable if the play leaves marks?        Yes No
Visible while wearing street clothes?                   Yes No
Visible while wearing a bathing suit?                    Yes No
Other
Acceptable if the play draws blood?                  Yes No
Explanation:
How easy or difficult has it been to mark the submissive in the past?

Erotic Humiliation
The submissive agrees to the following forms of erotic humiliation:
Verbal abuse                       Yes No
Enemas                               Yes No
Spitting                                Yes No
Water Sports                       Yes No
Scat games                          Yes No’

Other:
Any prior really good or really bad experiences in these areas?

Safe Words
Safe word #1 and its meaning:
Safe word #2 and its meaning:
Safe word #3 and its meaning:
Non-verbal safe words and their meaning:
Will “two-squeezes” be used?                        Yes No
Will dropping a set of car keys be used?        Yes No

Opportunities/Special Skills
Anything in particular either party would like to try and explore?
Follow-Up
After the session, a coming down period is needed.
The following day, discuss how things went.
A week later follow-up in case of post traumatic stress syndrome:
Post-session notes:
Dominant’s Favorite Part:
Dominant’s Least Favorite Part:
Dominant’s Most memorable part:
Dominant’s Other comments:
Submissive’s Best part:
Submissive’s Worst Part:
Submissive’s Most memorable:
Submissive’s Other comments:

Negotiation Questionnaire

Part One
What is your level of experience?
How long have you had or known of your interests?
What is your sexual orientation?
What kind of relationship do you prefer?
What is your main interest in scening?
What Do you classify yourself as?
What is your level of interest in bondage?
How do you view/consider pain in a session?
What do you believe the purpose of pain in a session is?
How do you view the neccessity of sex in a scene?
Which settings are you comfortable playing in?
Who can know of your activities?

Part Two
Role Playing. Listed below are several examples of roles to be played by either Dom or sub. List those which you are interested in, and those you’d like to see your partner play.

Amazon
Baby
Barbarian
Bitch-Goddess
Boss
Burglar
Child
Clergy
Cowboy
Cowgirl
Daddy
Doctor
Evil Priest
Evil Priestess
Femme Fatale
French Maid
God
Goddess
Hooker
Indian
Inquisitor
Interrogator
Hero
Kidnap Victim
Knight
Leather Man
Master
Mentor
Mistress
Mommy
Nun
Nurse
Rapist
Role Reversal
Pet
Pimp
Pirate
Policeman
Ponyboy
Ponygirl
POW
Prince
Princess
Principal
Puppy
Savage
Secretary
Sex Object
Sissy
Slave
Slave Owner
Slut
Student
Suspect
Teacher
Teen
Torturer
Victim
Warrior
Wild Beast

Roles I would like to play:
Roles I would like my partner to play: List any specific fetishes you have (i.e. foot worship, body types):
List any medical, physical or emotional concerns (past breaks, sprains, chronic conditions or phobias):
List your limits:
List your concerns about the depth and exclusivity of a relationship:
List your preferred method of birth control and avoidance of STD’s:

Part Three
Listed below are 6 parts of the body and 3 categories. Using the following letter codes, rate each as what is acceptable to you:
N = Never L = Light M = Medium H = Heavy T = Thuddy S = Stingy ? = Not Sure

Body Part Bondage Corporal Torture
Back/Shoulders ______ ______ ______
Bottom/Thighs ______ ______ ______
Breasts/Chest ______ ______ ______
Genitals ______ ______ ______
Feet/Ankles ______ ______ ______
Wrists ______ ______ ______

Part Four
Below are listed several D/s activities. Please rate each of these from 1 to 6:
1 = YES!!!
2 = Mmmm, I like this
3 = Doesn’t excite me, but I’d do it for my partner
4 = Intriguing, but scary
5 = Embarrassed to admit I want this
6 = Absolutely not!!

SEX
Anal penetration ____
Anal fisting ____
Anilingus ____
Cock worship (doing)____
Cunnilingus (giving)____
Direct masturbation ____
Double penetration (oral/anal)____
Eating/drinking cum (others’)____
Eating/drinking cum (own)____
Fantasy rape ____
Fellatio (giving)____
Intercourse ____
Oral sex ____
Strap-ons ____
Threesomes ____
Vaginal sex ____
Vibrator/dildo ____
BONDAGE
1-3 hour duration ____
3-6 hour duration ____
Overnight duration ____
Arm sleeves ____
Bondage (light)____
Bondage (heavy) ____
Cages ____
Ceiling/wall hooks ____
Collars (leather)____
Collars (other)____
Cotton ropes ____
Chains ____
Cuffs (leather)____
Cuffs (other)____
Gags (ball)____
Gags (funnel)____
Gags (panties)____
Gags (other)____
Genital bondage ____
Harnessing (suspended)____
Intricate rope bondage ____
Leather restraints____
Mental bondage ____
Mummification ____
Nylon rope ____
Saran wrapping ____
Shackles ____
Silk scarves____
Slings/swings ____
Spreader-bars ____
Spread-eagle____
Stocks ____
Straightjackets ____
Strapping – full body ____
Suspension (on toes)____
Suspension (full)____

PUNISHMENT
Belt/strap ____
Braided cat ____
Cane ____
Deerskin cat ____
Fiberglass/plastic rod ____
Leather cat ____
Leather paddle ____
Riding crop ____
Rubber whip ____
Single lash ____
Switch ____
Wooden paddle ____

FETISH ITEM
Boot worship ____
Corsets (wearing)____
Corsets (on others) ____
Foot Worship ____
Forced x dressing ____
High heel wearing ____
High heel worship ____
Uniforms ____
Latex wearing ____
Latex on others ____
Rubber wearing ____
Rubber on others ____
Leather wearing ____
Leather on others ____

HUMILIATION & EXHIBITION
Crossing dressing ____
Crawling ____
Dirty words ____
Face slapping ____
Foot kissing ____
Kneeling ____
Lead on leash ____
Public display ____
Pub. embarrassment ____
Public sex ____
Secret sex in public ____
Verbal abuse ____

BODILY FUNCTIONS
Breath Control ____
Brown showers ____
Catheterization ____
Eating/drinking own waste ____
Enemas ____
Physical Exams ____
Golden showers____
Medical scenes ____
Menstrual service ____
other Water Sports ____

INTENSE SENSATION (Aka PAIN)
Branding ____
Caning ____
Clip & Clamps ____
Cock/Ball torture ____
Cutting ____
Electrical play ____
Flogging ____
Heat ____
Needles (Play pierce)____
Scratching (giving)____
Scratching (receiving)____
Spanking (over knee)____
Spanking (other)____
Wax ____
Whipping (single tail)____
Whipping (other)____

OTHER
Blindfolded ____
Branding (for marking)____
Cock rings ____
Chosen clothing for ____
Chosen food for ____
Chosen toys for ____
Diapering ____
Exhibitionism ____
Fantasy rape ____
Following orders ____
Forced nudity ____
Forced servitude ____
Collared ____
Given away ____
Hair pulling ____
Hoods (leather)____
Hoods (metal)____
Hoods (other)____
Hot wax ____
(nude collared)____
Housework ____
Humiliation in private ____
Humiliation in public ____
Ice ____
Infantilism ____
Interrogations ____
Kidnapping ____
Kneeling ____
Knife play ____
Fire Play ____
Lectured ____
Licking (doing)____
Massage – giving ____
Mouth bits ____
Oils, lotions, spices ____
Piercing (permanent)____
Phone sex ____
Photographs ____
Plaster casting genitals ____
Romantic play ____
Sensory deprivation ____
Serving ____
Serving as ashtray ____
Serving as furniture ____
Serving as a maid ____
Serving as a pony ____
Shaving ____
Soap in mouth ____
Recruiting victims ____
Tattoos ____
Swapping ____
Teasing ____
Tickling ____
Verbal humiliation ____
Voyeurism ____
Videoed scenes ____
Miscellaneous Questions

1. For you, the turn on of D/s is:

2. What toys have the highest erotic value for you (1=some interest; 2=pretty exciting; 3=very erotic)
Whips
Floggers
Canes
Paddles
Electrical toys
Ropes
Chains
Leather Restraints
Wax
Knives
Nipple clamps
Clothespins
Paddles
Uniforms
Dildoes
Vibrators
Butt plugs
Gags
Handcuffs
Blindfolds
Belts
Harnesses
Slings
Boots
Shoes
Clothing
Collars

3. What parts of your body are most erotically sensitive:
4. What parts of your Dom’s body would you most like to pleasure:
5. List any known limits:

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