TM

CONSENT CHECKLIST
Old Gods of Appalachia is a horror setting and thus contains harrowing and scary elements that are inherent to gameplay.
If going through this form makes you realize horror settings aren’t for you, it’s okay to step away and play a different type of game.

GM Name:
Player Name: (or leave blank)
Planned Game Theme:
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.
G Y R G Y R
HORROR..................................... SOCIAL AND CULTURAL ISSUES....
Animal endangerment..................................... Bullying..............................................................
Blood.................................................................. Cults...................................................................
Body horror....................................................... Gun violence.....................................................
Child endangerment........................................ Homophobia.....................................................
Demonic possession........................................ Kidnapping........................................................
Dismemberment............................................... Racism................................................................
Eyeballs.............................................................. Real-world religion..........................................
Gore.................................................................... Religious trauma..............................................
Mind control..................................................... Sexism................................................................
Mines/underground scenarios........................ Slavery................................................................
Mutilation......................................................... Transphobia......................................................
Rats..................................................................... Other cultural issues........................................
Situations involving literal darkness.............
Snakes................................................................
Spiders............................................................... MENTAL AND PHYSICAL HEALTH.
Witchcraft......................................................... Abortion............................................................
Abuse.................................................................
Cancer................................................................
RELATIONSHIPS AND FAMILY....... Claustrophobia.................................................
Romance........................................................ Gaslighting........................................................
Fade to black............................................... Genocide............................................................
Explicit......................................................... Hanging/strangulation....................................
Between PCs and NPCs ........................... Miscarriage.......................................................
Between PCs............................................... Natural disasters..............................................
Sex...................................................................... Paralysis/physical restraint.............................
Fade to Black............................................... Police, police aggression.................................
Explicit......................................................... Self-harm...........................................................
Between PCs and NPCs............................ Severe weather..................................................
Between PCs .............................................. Sexual assault....................................................
Between my PC and another PC/NPC.... Starvation..........................................................
Family................................................................ Suicide................................................................
Abandonment............................................. Terrorism...........................................................
Death of a caretaker/parent...................... Thirst..................................................................
Death of a child.......................................... Torture (physical)..............................................
Death of a spouse....................................... Torture (psychological)....................................

ADDITIONAL TOPICS
Do you want the GM to follow up with you to clarify
any of these responses? If so, which ones?

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