RPG Consent Checklist

GM Name:

Player Name (or leave blank):

Planned Game Themes:

If this game were a movie, its rating would be: [G] [PG] [PG-13] [R] [NC-17] Other:

Mark the color that best matches your comfort level with the following plot or story topics:

♡ Blue = “I enthusiastically look forward to interacting in scenes involving this topic!”
◇ Green = “A scene involving this topic would be unlikely to make me uncomfortable.”
△ Yellow = “I would prefer not to play in a scene involving this topic. Better to keep it 'off-camera'.”
⦰ Red = “I would not be comfortable playing in a game involving this topic, even if it was 'off-camera'.”

This is not a contract! None of your answers have to be final, and you should feel free to change them at any time. If you do change your answers, or if you find yourself uncomfortable at any time during a game session, let the GM know, even if it involves a topic that you marked blue or green.

CATEGORY	Detail	Rating
HORROR	Any/all horror themes	♡	◇	△	⦰
	Body parts - e.g. eyeballs, genitals, teeth	♡	◇	△	⦰
	Demons & Devils	♡	◇	△	⦰
	Gore	♡	◇	△	⦰
	Harm to animals	♡	◇	△	⦰
	Harm to children	♡	◇	△	⦰
	Vermin (insects, rats, snakes, spiders, etc.)	♡	◇	△	⦰
MENTAL AND PHYSICAL HEALTH	Any/all mental/physical health themes	♡	◇	△	⦰
	Amputation	♡	◇	△	⦰
	Cancer	♡	◇	△	⦰
	Chronic illness	♡	◇	△	⦰
	Claustrophobia	♡	◇	△	⦰
	Dementia	♡	◇	△	⦰
	Freezing to death	♡	◇	△	⦰
	Heatstroke	♡	◇	△	⦰
	Infection (bacterial, fungal, parasitic, viral)	♡	◇	△	⦰
	Paralysis or physical restraint	♡	◇	△	⦰
	Pregnancy, miscarriage, or abortion	♡	◇	△	⦰
	Self-harm	♡	◇	△	⦰
	Suicide	♡	◇	△	⦰
	Thirst	♡	◇	△	⦰
	Torture	♡	◇	△	⦰
RELATIONSHIPS	Any/all relationship themes	♡	◇	△	⦰
	Abuse, emotional or physical	♡	◇	△	⦰
	Divorce	♡	◇	△	⦰
	Gaslighting	♡	◇	△	⦰
	Romance between PCs	♡	◇	△	⦰
	Romance between PCs and NPCs	♡	◇	△	⦰
	Sexual assault	♡	◇	△	⦰
	Sex between PCs and NPCs	♡	◇	△	⦰
	Sex between PCs	♡	◇	△	⦰
	Starvation	♡	◇	△	⦰
SOCIAL & CULTURAL ISSUES	Any/all social & cultural themes	♡	◇	△	⦰
	Genocide	♡	◇	△	⦰
	Homelessness (and its associated issues)	♡	◇	△	⦰
	Homophobia	♡	◇	△	⦰
	Police, police aggression	♡	◇	△	⦰
	Racism (versus fantasy races)	♡	◇	△	⦰
	Racism (versus real-world peoples)	♡	◇	△	⦰
	Religion &/or religious persecution	♡	◇	△	⦰
	Sexism	♡	◇	△	⦰
	Slavery	♡	◇	△	⦰
	Terrorism	♡	◇	△	⦰
	War (and its social effects)	♡	◇	△	⦰
ADDITIONAL TOPICS	Write in any additional topics in the blanks	♡	◇	△	⦰
	Natural disasters	♡	◇	△	⦰
	Severe weather	♡	◇	△	⦰
		♡	◇	△	⦰
		♡	◇	△	⦰
		♡	◇	△	⦰
		♡	◇	△	⦰
		♡	◇	△	⦰
		♡	◇	△	⦰

HORROR ♡ ◇ △ ⦰
- Body parts - e.g. eyeballs, genitals, teeth ♡ ◇ △ ⦰
- Demons & Devils ♡ ◇ △ ⦰
- Gore ♡ ◇ △ ⦰
- Harm to animals ♡ ◇ △ ⦰
- Harm to children ♡ ◇ △ ⦰
- Vermin (insects, rats, snakes, spiders, etc.) ♡ ◇ △ ⦰
MENTAL AND PHYSICAL HEALTH ♡ ◇ △ ⦰
- Amputation ♡ ◇ △ ⦰
- Cancer ♡ ◇ △ ⦰
- Chronic illness ♡ ◇ △ ⦰
- Claustrophobia ♡ ◇ △ ⦰
- Disease ♡ ◇ △ ⦰
- Freezing to death ♡ ◇ △ ⦰
- Heatstroke ♡ ◇ △ ⦰
- Paralysis or physical restraint ♡ ◇ △ ⦰
- Pregnancy, miscarriage, or abortion ♡ ◇ △ ⦰
- Self-harm ♡ ◇ △ ⦰
- Suicide ♡ ◇ △ ⦰
- Thirst ♡ ◇ △ ⦰
- Torture ♡ ◇ △ ⦰
RELATIONSHIPS ♡ ◇ △ ⦰
- Abuse, emotional or physical ♡ ◇ △ ⦰
- Divorce ♡ ◇ △ ⦰
- Gaslighting ♡ ◇ △ ⦰
- Romance between PCs ♡ ◇ △ ⦰
- Romance between PCs and NPCs ♡ ◇ △ ⦰
- Sexual assault ♡ ◇ △ ⦰
- Sex between PCs and NPCs ♡ ◇ △ ⦰
- Sex between PCs ♡ ◇ △ ⦰
- Starvation ♡ ◇ △ ⦰
SOCIAL & CULTURAL ISSUES ♡ ◇ △ ⦰
- Genocide ♡ ◇ △ ⦰
- Homelessness (and its associated issues) ♡ ◇ △ ⦰
- Homophobia ♡ ◇ △ ⦰
- Police, police aggression ♡ ◇ △ ⦰
- Racism (versus fantasy races) ♡ ◇ △ ⦰
- Racism (versus real-world peoples) ♡ ◇ △ ⦰
- Religion &/or religious persecution ♡ ◇ △ ⦰
- Sexism ♡ ◇ △ ⦰
- Slavery ♡ ◇ △ ⦰
- Terrorism ♡ ◇ △ ⦰
- War (and its social effects) ♡ ◇ △ ⦰
ADDITIONAL TOPICS ♡ ◇ △ ⦰
- Natural disasters ♡ ◇ △ ⦰
- Severe weather ♡ ◇ △ ⦰

♡ ◇ △ ⦰

♡ ◇ △ ⦰ ♡ ◇ △ ⦰

♡ ◇ △ ⦰ Do you want the GM to follow up with you to clarify any of these responses? If so, which ones? __