BDSM SCENE CONSENT FORM

Participant Information:

Full Name (Bottom/Submissive):

__________________________________

Date of Birth (Bottom/Submissive): __________________________________

Contact Information (Bottom/Submissive): __________________________________

Emergency Contact (Name and Phone Number):

__________________________________

Relationship to Emergency Contact: __________________________________

Dominant:

Full Name (Top/Dominant): __________________________________

Contact Information (Top/Dominant):

__________________________________

Scene/Activity Details:

I acknowledge that this scene/activity involves the following elements (please initial next to each activity to confirm understanding): _______ CBT (Cock and Ball Torture)

_______ Humiliation and Degradation

_______ Sissyfication

_______ Sexually Explicit Activities

_______ Impact Play (canes/whips)

_______ Sadomasochism (pegs/rope/hair ties)

I understand that this scene is based on BDSM and role play.

Additional Notes:

_________________________________________________________________________________________________________

_________________________________________________________________________________________________________ ______________________________________________________________________________________.

 

Voluntary Participation:

I confirm that my participation is voluntary and that I have not been coerced or pressured into taking part. I understand that consent can be withdrawn at any time without consequence.

Signature (Bottom/Submissive):

__________________________________

Signature (Top/Dominant):

__________________________________

Additional Notes:

_________________________________________________________________________________________________________

_________________________________________________________________________________________________________ ______________________________________________________________________________________.

 

Risks and Discomforts:

I understand that there may be certain risks and discomforts associated with the scene/activity. These include, but are not limited to:

• Bruising/physical marks
• Sub space (a state of heightened relaxation or dissociation, which can sometimes lead to feelings of depression)
• Pain in genital area (CBT), including busting balls and bruising

I acknowledge these potential risks and discomforts and have consulted a healthcare professional if I have any concerns.

Signature (Bottom/Submissive):

__________________________________

Signature (Top/Dominant):

__________________________________

Additional Notes:

_________________________________________________________________________________________________________

_________________________________________________________________________________________________________ ______________________________________________________________________________________.

Confidentiality:

I understand that all personal information and details of the scene/activity will be kept confidential and will not be disclosed without my explicit consent, except as required by law. Measures will be taken to ensure confidentiality, and data will be stored securely with access limited to authorized individuals.

Signature (Bottom/Submissive):

__________________________________

Signature (Top/Dominant):

__________________________________

Additional Notes:

_________________________________________________________________________________________________________

_________________________________________________________________________________________________________ ______________________________________________________________________________________.

Right to Withdraw:

I understand that I have the right to withdraw from the scene/activity at any time, without any penalty or loss of benefits to which I am otherwise entitled. I understand and agree to use the following safeword system:

RED: Stop immediately

AMBER: Danger zone/no more pressure

GREEN: Continue

I am fully confident in my ability to use the safeword system and will use it without hesitation. I confirm that I have discussed the safeword system and its usage with the Dominant.

Signature (Bottom/Submissive):

__________________________________

Signature (Top/Dominant):

__________________________________

Additional Notes:

_________________________________________________________________________________________________________

_________________________________________________________________________________________________________ ______________________________________________________________________________________.

 

Health Conditions:

Please list any past or existing health conditions (e.g., heart conditions, history of strokes), allergies, or medications you are taking, even if you do not think they are relevant:

_________________________________________________________________________________________________________

_________________________________________________________________________________________________________ ______________________________________________________________________________________.

I understand the importance of disclosing all relevant health information.

Signature (Bottom/Submissive):

__________________________________

Signature (Top/Dominant):

__________________________________

Aftercare Preferences:

I understand that aftercare is an extremely important part of the scene. Aftercare can vary from person to person; some may prefer hugs and conversation, while others may prefer to be left alone for a while. Please list your aftercare preferences below:

_________________________________________________________________________________________________________

_________________________________________________________________________________________________________ ______________________________________________________________________________________.

Examples of aftercare activities:

• Physical comfort (hugs, blankets)
• Emotional support (conversation, reassurance)
• Alone time (quiet space, rest)

The Dominant acknowledges understanding the participant’s aftercare needs.

Signature (Bottom/Submissive):

__________________________________

Signature (Top/Dominant):

__________________________________

 

Explicit Consent:

I understand that I am not allowed to touch __________________________________

without explicit consent to do so.

 

 

Dungeon Rules:

I understand that the scene will take place at __________________________________, a rented BDSM dungeon, and that all parties must respect the rules and regulations set by the establishment. I agree to abide by these rules during the scene.

Signature (Bottom/Submissive):

__________________________________

Signature (Top/Dominant):

__________________________________

Additional Notes: _________________________________________________________________________________________________________

_________________________________________________________________________________________________________ ______________________________________________________________________________________.

Top’s Comprehensive Insight:

I acknowledge that the Top, __________________________________ , has comprehensive insight necessary to conduct this scene to the best of her abilities under the CCCC framework (Communication, Consent, Care, Caution), confirmed in separate documents from this consent form.

Signature (Bottom/Submissive):

__________________________________

Signature (Top/Dominant):

__________________________________

Additional Notes:

_________________________________________________________________________________________________________

_________________________________________________________________________________________________________ ______________________________________________________________________________________

 

Liability Waiver:

I acknowledge that I am voluntarily participating in this scene/activity and fully understand the potential risks involved. I agree to release, indemnify, and hold harmless __________________________________

from any and all liabilities, claims, demands, or causes of action that may arise from or relate to my participation in this scene, including any physical or psychological injury that may occur.

Signature (Bottom/Submissive):

__________________________________

Signature (Top/Dominant):

__________________________________

Additional Notes:

_________________________________________________________________________________________________________

_________________________________________________________________________________________________________ ______________________________________________________________________________________.

Final Acknowledgement:

By signing below, I acknowledge that I have read and understood all the above information, and I consent to participate in the scene/activity as described. The Dominant confirms she has reviewed the form with the participant and discussed any questions or concerns.

Participant Signature (Bottom/Submissive):

__________________________________

Full Name (Bottom/Submissive):

__________________________________

Date:

__________________________________

Dominant Signature (Top/Dominant):

__________________________________

 

Please click below to download a copy of the above file. It is available in word and PDF format.

You will need to print a physical copy of the PDF.

 

For PDF please click here – https://www.twistedboudoir.co.uk/wp-content/uploads/2025/07/bdsm-consent-form-pdf.pdf

for DocX please click here – https://www.twistedboudoir.co.uk/wp-content/uploads/2025/07/bdsm-consent-form.docx

Users are reminded that this document is NOT legally binding in the UK. Participation in BDSM activities has no right to consent in the UK. This document is designed for negotiation and information and is not a legal document. Be aware – even after signing this document you will still be breaking the Law by partaking in BDSM activities.