Of my own free will, as of _______(date), I ___________(name), hereby grant you, ____________(name), full ownership and use of my body and mind from now until __________(date). .
I will obey you at all times and will wholeheartedly seek your pleasure and well-being above all other considerations. I renounce all rights to my own pleasure, comfort, or gratification ,except insofar as you desire or permit them.
I will strive diligently to re-mold my body, my habits, and my attitudes in accordance with your desires. I will seek always to learn how to please you better,and will gracefully accept criticism.
I renounce all rights to privacy or concealment from you. I will answer truthfully and completely, to the best of my knowledge, any and all questions you may ask me I understand and agree that any failure by me to comply fully with your desires shall be regarded as sufficient cause for possibly severe punishment.
Within the limits of physical safety and my ability to earn a livelihood, I otherwise unconditionally accept as your perogative anything you may choose to do with me, whether as punishment, for your amusement, or for whatever purpose, no matter how painful or humiliating to myself.
_____________________(name)
_____________________(date)
_____________________(place)