Safety & Consent Form - Vallombrosa Campaign

Thank you for taking the time to complete this form! Your responses help create a fun, comfortable, and inclusive game for everyone. All responses are confidential and will only be shared with the DM unless you indicate otherwise.

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Player Information

Name/Preferred Name *

Pronouns *

Date *

Preferred Contact Method *

Communication Preferences

How do you prefer to give feedback about the game? (Check all that apply)

During the session

Privately after the session (in person)

Via text/email/Discord

Anonymous form

Other:

If something makes you uncomfortable during a session, how would you like to handle it?

Use a safety tool (X-Card, Script Change, etc.)

Private message/signal to DM

Take a break and discuss privately

Other:

Content Boundaries

How to use this section: For each topic, select your comfort level:

Boundary = Hard "no" — this will not appear in the game
Line = Never shown directly on-screen; may be briefly mentioned in passing but will never be a plot point
Veil = Can be a plot point and discussed, but never glamorized or acted out in detail (fade to black/off-screen)
OK = Comfortable with this content

Violence & Combat

Topic	Boundary	Line	Veil	OK
Standard Fantasy Combat
Graphic/Detailed Violence
Torture/Interrogation
Body Horror/Gore
Eye Trauma/Mutilation
Cannibalism
Violence Against Children
Violence Against Animals/Companions
Permanent Injury/Maiming (PCs)

Death & Undeath

Topic	Boundary	Line	Veil	OK
Death (General)
PC Death Stakes
Undeath/Corpses/Zombies
Terminal Illness

Horror & Psychological

Topic	Boundary	Line	Veil	OK
Psychological Horror
Cosmic/Existential Horror
Jump Scares
Psychological Harm/Gaslighting
Memory Alteration
Mind Control/Enchantment
Possession/Loss of Control
Loss of Agency (General)

Common Phobias

Topic	Boundary	Line	Veil	OK
Spiders/Insects
Snakes/Swarms
Deep Water/Drowning
Heights/Vertigo
Claustrophobia/Confined Spaces
Disease/Plague

Social & Difficult Themes

Topic	Boundary	Line	Veil	OK
Slavery/Oppression
Racism/Discrimination (in-world)
Sexism/Misogyny
Religious/Cult Themes
Religious Persecution
Child Abuse/Endangerment
Domestic Violence
Pregnancy/Childbirth
Substance Abuse
Substances (alcohol/drugs in-game)
Suicide/Self-Harm

Societal & Systemic

Topic	Boundary	Line	Veil	OK
War/Atrocities
Crime/Corruption
Economic Suffering/Poverty
Environmental Threats
Moral Dilemmas (no good choice)

Romance & Sexual Content

Topic	Boundary	Line	Veil	OK
Romance Between PCs
Romance with NPCs
Flirting/Seduction Checks
Sexual Content (fade to black)
Explicit Sexual Content

Player vs Player Dynamics

Topic	Boundary	Line	Veil	OK
PvP Combat
PvP Social/Political Conflict
Theft From Other PCs
Betrayal Between Party Members

Additional Topics

Topic	Boundary	Line	Veil	OK
Permanent Character Consequences

Specific Triggers or Hard Limits

Please list any specific topics, themes, imagery, or situations not covered above that are absolute hard limits for you. Be as specific as you'd like—there's no judgment here.

Safety Tools & Protocols

The following safety tools will be available at our table:

X-Card

Anyone can touch/tap the X-card (physical or virtual) to skip content immediately, no questions asked, no explanation needed.

I'm comfortable using this tool

I'd prefer a different system:

Boundaries, Lines, & Veils

Boundaries - Hard limits. These things do not exist in the campaign.
Lines - Never shown directly on-screen and will never be a plot point.
Veils - Off-screen or implied and can serve as plot points.

I'm comfortable with this framework

I need clarification or have concerns:

Script Change Tools

Pause – Temporarily stop the scene to discuss or adjust
Fast-Forward – Skip ahead past uncomfortable content

I'm comfortable using these tools

Open Door Policy

Anyone can step away from the session at any time, for any reason, with no explanation required.

I understand and am comfortable with this policy

Check-Ins

Quick vibes/comfort check during breaks, plus optional short debrief after sessions.

I'm comfortable with periodic check-ins

I prefer:

Additional Comments

Is there anything else you'd like the DM to know to help make this campaign enjoyable and safe for you?

Agreement & Understanding

By completing this form, I understand that:

✓ The DM will do their best to respect these boundaries
✓ I can update my responses at any time, and changes will be respected immediately
✓ I will communicate if my comfort levels change during the campaign
✓ Safety tools are available and can be used without judgment
✓ I'm responsible for my own well-being and will speak up if I need to
✓ This is a collaborative effort to ensure everyone has fun

Thank you for completing this form! Your input helps create a better, safer experience for everyone at the table. This form can be revisited and updated at any time.