Sexual Consent Form #101 Revision 1.02 This form is to be used in situations involving two distinct parties, one male and one female. Other available forms are as follows: #102: Two parties, both male #103: Two parties, both female #104: Three parties, one male and two female #105: Three parties, two male and one female #106: Three or more parties, all male #107: Three or more parties, all female #108: Four or more parties, mixed male and female Failure to use the proper form will result in invalidation of all consent information. Should the situation change after a form has already been filled out, a new form of the proper type must be filled out. All forms that have been used in a single situation must be kept together for legal purposes. Only one form is necessary for each group of a particular type, however a copy may be filled out for each individual if so desired. Section I: Initial Information Date: __/__/__ Starting time: __:__:__ Ending time (optional): __:__:__ Parties Involved (Please Print): Male: ______________________________, ______________________________ __ Last First MI Female: ______________________________, ______________________________ __ Last First MI Section II: Casual Interaction Failure to adhere to the agreements in this section may result in one party disliking the other party for an unknown period of time. Activity Description Initials (M) Initials (F) _ All Section II activities X____________ X____________ _ Looking at each other X____________ X____________ _ Talking to each other (casual) X____________ X____________ _ Talking to each other (personal) X____________ X____________ _ Watching television, listening to music, reading books, or participating in any other everyday activity together X____________ X____________ Section III: Physical Interaction Failure to adhere to the agreements in this section may result in sexual harassment charges being filed. Activity Description Initials (M) Initials (F) _ All Section III activities X____________ X____________ _ Kissing (no tongues) X____________ X____________ _ Kissing (tongues) X____________ X____________ _ Kissing, licking, nibbling, or otherwise applying mouth to face, neck, ears, fingers, or toes X____________ X____________ _ Touching, feeling, caressing, fondling, groping, or massaging (through clothing) the following body parts: _ All body parts X____________ X____________ The following body parts: Body Part or Area M|F|B _ _________________________________________ _|_|_ X____________ X____________ _ _________________________________________ _|_|_ X____________ X____________ _ _________________________________________ _|_|_ X____________ X____________ _ _________________________________________ _|_|_ X____________ X____________ _ _________________________________________ _|_|_ X____________ X____________ _ Touching, feeling, caressing, fondling, groping, or massaging (on bare skin) the following body parts: _ All body parts X____________ X____________ The following body parts: Body Part or Area M|F|B _ _________________________________________ _|_|_ X____________ X____________ _ _________________________________________ _|_|_ X____________ X____________ _ _________________________________________ _|_|_ X____________ X____________ _ _________________________________________ _|_|_ X____________ X____________ _ _________________________________________ _|_|_ X____________ X____________ Section IV: Sexual Interaction Failure to adhere to the agreements in this section may result in rape charges being filed. Activity Description Initials (M) Initials (F) _ All Section IV activities X____________ X____________ _ Sexual intercourse X____________ X____________ _ Oral sex (on male) X____________ X____________ _ Oral sex (on female) X____________ X____________ _ Anal sex X____________ X____________ Section V: Other Sexual Interaction Failure to adhere to the agreements in this section may result in some rather unusual situations, as well as possible rape or assault charges, traffic violations, personal complaints, public humiliation (unless that is what is desired), or just about anything else you could possibly imagine. The following activities have been consented to: Description of Activity Initials (M) Initials (F) _ _____________________________________________________________________________ ________________________________________________ X____________ X____________ _ _____________________________________________________________________________ ________________________________________________ X____________ X____________ _ _____________________________________________________________________________ ________________________________________________ X____________ X____________ _ _____________________________________________________________________________ ________________________________________________ X____________ X____________ Section VI: Items The following items may be used in the activities listed above in Sections III, IV, and V: Description of Item Initials (M) Initials (F) _ ________________________________________________ X____________ X____________ _ ________________________________________________ X____________ X____________ _ ________________________________________________ X____________ X____________ _ ________________________________________________ X____________ X____________ _ ________________________________________________ X____________ X____________ _ ________________________________________________ X____________ X____________ Section VII: Final Agreement We, X___________________, and X___________________, declare that our judgement is not impaired in any way, and we do hereby agree that we consent to all activities above which we have jointly chosen and initialed. Witnesssed by: Signed: X___________________ X___________________ Printed: X___________________ X___________________ 1997 Matthew M. Lug
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