Sexual Consent Form

Fill out this Sexual Consent Form.

Questions for Sexual Consent Form

1.

Name of Proposing Party

The answer should be a text input.
2.

Gender

The answer should be a single choice:
  1. Male
  2. Female
  3. Other
  4. Prefer not to say
3.

Date of Birth

The answer should be a date input.
4.

Date of last medical Check-up

The answer should be a date input.
5.

Name of Consented Party

The answer should be a text input.
6.

Gender

The answer should be a single choice:
  1. Male
  2. Female
  3. Other
  4. Prefer not to say
7.

Date of Birth

The answer should be a date input.
8.

Date of last medical Check-up

The answer should be a date input.
9.

Body Fondling

The answer should be a single choice:
  1. Proposing Party
  2. Consented Party
10.

Body Licking

The answer should be a single choice:
  1. Proposing Party
  2. Consented Party
11.

Torrid Kissing

The answer should be a single choice:
  1. Proposing Party
  2. Consented Party
12.

Bondage and Discipline

The answer should be a single choice:
  1. Proposing Party
  2. Consented Party
13.

Effectivity From

The answer should be a date input.
14.

Effective Until

The answer should be a date input.
15.

The Parties hereby declare that this agreement is made by the free will of them without threat, harm, or intimidation. The Parties understand and were made aware to each other that they are of legal age. The Parties likewise agree that this agreement is deemed considered as private and not to be disclosed to third parties, except in cases where necessary disclosure shall be needed such as disputes civil or criminal. The Parties declare that both are free from any sexually transmissible diseases. An infection contracted by one after the engagement consummating this agreement shall hold the other party liable for damages both civil and criminal.

The answer should be a single choice:
  1. I agree
  2. I disagree
16.

Signature of Proposing Party

The answer should be a signature.
17.

Date Signed

The answer should be a date input.
18.

Signature of Consented Party

The answer should be a signature.
19.

Date Signed

The answer should be a date input.

Loved by people at home
and at work

“BlockSurvey is a simple, effective, and scalable tool for creating surveys for leadership and learning assessment. It's one of this year's best buying choices. Each month, it keeps improving and strives to serve its customers needs.”
Nelson Emilio
Personal Branding Strategist
“I use BlockSurvey to get feedback about all my activities and events. It is really easy to get started and create my first surveys! Then I could see how easy it was to share them. Now I am thinking to use BlockSurvey also within my creative process as an author in order to listen and engage with my audience, knowing that anonymity provides the most sincere and reliable answers.”
Georgina García-Mauriño
Author & Designer
BlockSurvey social proof
G2 Crowd
4.8 Star Rating
BlockSurvey social proof
Dapp.com
Editor's choice
BlockSurvey social proof
Capterra
4.9 Star Rating

What's next? Try out templates like
Sexual Consent Form

500+ Templates, 50+ Integrations