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    Consent Form

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    © All Rights Reserved
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    Consent Form

    Uploaded by

    ey
    51 views1 page

    Copyright

    © © All Rights Reserved

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    PDF, TXT or read online from Scribd

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    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    51 views1 page

    Consent Form

    Uploaded by

    ey

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    RPG CONSENT CHECKLIST

    GM Name: mightypepe

    Player Name: (or leave blank) Geld

    Planned Game Theme: Castle Crashers

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

    Mark the color that best illustrates your comfort level with the following plot or story elements.
    Green = Enthusiastic consent; bring it on!
    Yellow = Okay if veiled or offstage; might be okay onstage but requires discussion ahead of time; uncertain.
    Red = Hard line; do not include.

    HORROR. . ............................................................. MENTAL AND PHYSICAL HEALTH...............


    G Y R G Y R

    Bugs................................................................ ✔ Cancer............................................................. ✔
    Blood............................................................... ✔ Claustrophobia............................................... ✔
    Demons.......................................................... ✔ Freezing to death............................................ ✔
    Eyeballs........................................................... ✔ Gaslighting...................................................... ✔
    Gore................................................................ ✔ Genocide......................................................... ✔
    Harm to animals............................................ ✔ Heatstroke ..................................................... ✔
    Harm to children............................................ ✔ Natural disasters (earthquakes, forest fires) ✔
    Rats................................................................. ✔ Paralysis/physical restraint............................ ✔
    Spiders............................................................ ✔ Police, police aggression................................ ✔
    Pregnancy, miscarriage, or abortion.............. ✔

    Self-harm......................................................... ✔
    Severe weather (hurricanes, tornados) ........ ✔
    Sexual assault................................................. ✔
    RELATIONSHIPS................................................ Starvation........................................................ ✔
    Romance......................................................... ✔ Terrorism......................................................... ✔
    Fade to black............................................. ✔ Torture............................................................. ✔
    Explicit....................................................... Thirst .............................................................. ✔
    Between PCs and NPCs ........................... ✔

    Between PCs............................................. ✔

    Sex................................................................... ✔

    Fade to Black............................................. ✔

    Explicit....................................................... ✔

    Between PCs and NPCs............................


    ADDITIONAL TOPICS
    ✔

    Between PCs ............................................ ✔


    Nothing with Children... ✔

    SOCIAL AND CULTURAL ISSUES..................


    Homophobia.................................................. ✔

    Racism............................................................ ✔

    Real-world religion.......................................... ✔ Do you want the GM to follow up with you to clarify


    Sexism............................................................. ✔ any of these responses? If so, which ones?
    Specific cultural issues................................... ✔

    ©2019 Monte Cook Games, LLC. Cypher System and its logo are trademarks of Monte Cook Games, LLC in the United States and other countries. Permission granted to duplicate for personal use.

    TM and ©2019 Monte Cook Games, LLC. Permission granted to duplicate for personal use.

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