Activity Check List
 
For each item, you need to provide two answers:

For experience, write YES or NO next to each item to indicate if you have ever DONE that activity

For willingness, indicate for each item how you feel about DOING that activity by rating it on a scale of  0 to 5.

"?" means you don't understand what the item is attempting to describe.
NO means you will NOT do that item under any circumstances (a hard limit).
0 (zero) indicates you have utterly no desire to do that activity and don't like doing it (in fact, may loath it) and would ordinarily object to doing it, but you would if the Master really wanted it. (some times called a "soft limit").

1 means you don't want to do or like to do this activity, but wouldn't object if it was asked of you.
2 means you are willing to do this activity, but it has no special appeal for you.
3 means you usually like doing this activity, at least on an irregular/ occasional basis.
4 means you like doing this activity, and would like to experience it on a regular basis.
5 means the activity is a wild turn-on for you, and you would like it as often as possible.

Note any additional information which might be important for your Master to know.  Next to each item on the list.

There is intentionally some overlap between categories. Unless otherwise stated, the Sub/Slave is the recipient of the activity. 

The List:
Abrasion
Age play
Anal sex
Anal plugs (small)
Anal plugs (large)
Anal plug (public, under clothes)
Arm & leg sleeves (armbinders)
Aromas   
Asphyxiation
Auctioned for charity
Bathroom use control
Beastiality
Beating (soft)
Beating (hard)
Blindfolds
Being serviced (sexual)
Being bitten
Boot worship
Bondage (light)
Bondage (heavy)
Bondage (multi-day)
Bondage (public, under clothing)
Branding
Breast/chest bondage
Breast whipping
Breath control
Bruises
Cages (locked inside of)
Caning
Catheterization
Cells/Closets (locked inside of)
Chains   
Chamber-pot use  
Chastity belts (short term)
Chastity belts (multi-day)
Chauffeuring (driving)
Choking
Chores (domestic service)
Clothespins
Cock worship
Collars (worn in private)
Collars (worn in public)
Competitions (with other Subs)
Corsets (wearing casually)
Corsets (trained waist reduction)
Cross-dressing
Cuffs (leather)
Cuffs (metal)
Cutting
Dilation
Dildoes   
Double penetration
Electricity
Enemas (for cleansing)
Enemas (retention/punishment)
Enforced chastity
Erotic dance (for audience)
Examinations (physical)
Exercise (forced/required)
Exhibitionism (friends)
Exhibitionism (strangers)
Eye contact restrictions
Face slapping
Fantasy abandonment
Fantasy rape
Fantasy gang-rape
Fear (being scared) 
Fisting (anal)
Fisting (vaginal)
Flame play  
Following orders
Food play (cucumbers, sorbet...)
Foot worship
Forced bedwetting
Forced dressing
Forced eating
Forced homosexuality
Forced heterosexuality
Forced masturbation
Forced nudity (private)
Forced nudity (around others)
Forced servitude
Forced smoking
Full head hoods
Gags (cloth)
Gags (inflatable) 
Gags (phallic)
Gags (rubber)
Gags (tape
Genital sex
Given away to another Dom (temp)
Given away to another Dom (perm)
Golden showers
Hairbrush spankings
Hair pulling
Hand jobs (giving)
Hand jobs (receiving)
Harems (serving w/other subs)
Harnessing (leather)
Harnessing (rope)
Having food chosen for you
Having clothing chosen for you
Head (give fellatio/cunnilingus)
Head (recv fellatio/cunnilingus)
High heel wearing
High heel worship
Homage with tongue (non-sexual)
Hoods   
Hot oils (on genitals)
Hot waxing
Housework (doing)
Human puppy dog
Humiliation (private)
Humiliation (public)
Humiliation (verbal)
Hypnotism
Ice cubes
Immobilization
Including others  
Infantilism
Initiation rites
Injections
Intricate (Japanese) rope bondage
Interrogations
Kidnapping
Kneeling
Knife play  
Leather clothing
Leather restraints
Lectures for misbehavior
Licking (non-sexual)
Lingerie (wearing)
Manacles & Irons
Manicures (giving)
Massage (giving)
Massage (receiving)
Medical scenes
Modeling for erotic photos
Mouth bits
Mummification
Name change (for scene)
Name change (legal, permanent)
Nipple clamps
Nipple rings (piercing)
Nipple play/"torture" 
Nipple weights
Oral/anal play (rimming)
Over-the-knee spanking
Orgasm denial
Orgasm control
Outdoor scenes
Outdoor sex
Pain (mild)  
Pain (medium)
Pain (severe)  
Personality training (in scene)
Personality modification (RL)
Phone sex (serving Dom)
Phone sex (serving Dom's friends)
Phone sex (commercial provider)
Piercing (temporary, play-pierce)
Piercing (permanent)
Plastic surgery
Prison scenes
Prostitution (public pretence)
Prostitution (actual)
Pony slave
Public exposure
Punishment Scene 
Pussy/cock whipping
Pussy worship
Riding crops
Riding the "horse" (crotch torture)
Rituals
Religious scenes
Restrictive rules on behavior
Rubber/latex clothing
Rope body harness
Saran wrapping
Scarification
Scratching - getting
Scratching - giving
Sensory deprivation
Serving
Serving as art
Serving as furniture
Serving as a maid
Serving as toilet (urine)
Serving as waitress/waiter
Serving orally (sexual)
Serving other doms (supervised)
Serving other doms (unsupervised)
Sexual deprivation (short term)
Sexual deprivation (long term)
Shaving (body hair)
Shaving (genital hair)
Shaving (head hair)
Skinny-dipping
Sleep deprivation
Slutty clothing (private)
Slutty clothing (public)
Spandex clothing
Spanking
Speech restrictions (when, what)
Speculums (Anal)
Speculums (vaginal)
Spitting  
Spreader bars
Standing in corner
Stocks
Straight jackets
Strap-on-dildos (sucking on)
Strap-on-dildos (penetrated by)
Strap-on-dildos (wearing)
Strapping (full body beating)
Suspension (upright)
Suspension (inverted)
Suspension (horizontal)
Supplying new partners for Dom
Swallowing semen
Swallowing urine
Swapping (with one other couple)
Swinging (multiple couples)
Tattooing
Teasing
TENS Unit (electrical toy)
Thumbcuffs (metal) 
Tickling
Triple penetration
Urethral Sounds (metal rods)
Uniforms
Vaginal dildo
Verbal humiliation
Vibrator on genitals
Violet Wand (electrical toy)
Voyeurism (watching others)
Voyeurism (your Dom w/others)
Video (watching others)
Video (recordings of you)
Water torture
Waxing (hair removal) 
Wearing symbolic jewelry
Weight gain (forced)
Weight loss (forced)
Whipping
Wooden paddles
Wrestling

List any additional information that may be useful to the Master in making his decisions regarding the activities he expects you to participate in.