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.
HERE

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.

© 2006 Dr. Ava Cadell. All rights reserved.

www.avacadell.com