Sexual Consent Forms

Sexual Consent Form
&
Right of Privacy Agreement
I, ________________________________, hereby declare under penalty of perjury
that I am over 18 years old.
I further declare that this agreement is of my own free will and that neither I nor
anyone near or dear to me has been threatened with harm or embarrassment.
Both parties agree that this is a private agreement not to be disclosed to third
parties except in case of accusation of sexual misconduct by the agreeing party. If
he/she shows or makes public this agreement without accusation of sexual
misconduct, it is agreed that he/she will be liable for damages for invasion of
privacy.
By initialing, _____ I agree to engage in all or some of the following consensual acts.
􀀀 Sexual fondling and kissing
􀀀 Oral copulation (mutual)
􀀀 Oral copulation (unilateral) by _____________________only
􀀀 Sexual intercourse with an FDA approved condom at all times
Other consensual sexual conduct to be specified:
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
I further declare that I am at this time not under the influence of alcohol, drugs or
medication and agree to engage in consensual sex with:
__________________________________
At this time I do not intend to change my mind before the sex act or acts are over.
However, if I do, it is further understood that when I say the words “CODE RED” my
partner agrees to STOP INSTANTLY!
Signed: _________________________ Date: __________________________
Signed: _________________________ Date: ____________________________
Disclaimer: Check with your attorney before entering into any agreement.

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