Online Screening Questionaire for Couples

Applying as: Couple •click here to apply as a single
 
  MALE FEMALE
Name:
First:  
Last:  
First:  
Last:  
State of Residence:    
Phone Number:  
Email:    
Best way to reach you?





Level of Experience:      
General Agreement: In order to be considered for Bluegrass Secrets (BGS) membership, we ask that you indicate your agreement or disagreement with each of the following statements:

We are both at least twenty-one (21) years of age:
 
 
We are a married couple:
 
 
We are a couple in the lifestyle only and not married to either one another or to anyone else:
 
 
NOTE: Individuals who are married to persons other than their co-applicants must explain their circumstances in separate statements in order to be considered for membership.
 
Explain your understanding of an "On-Premise" club:   
 
I recognize and accept that BGS is a private social club for discreet adult couples and select singles committed to sexually oriented alternative lifestyles & that BGS is an “On-Premise” Club. I am are neither offended by nor uncomfortable with the actives that take place in an “On-Premise” Club & if selected to be members of BGS, we will accept and agree under all circumstances to abide by the club’s rule that ’No’ always means ‘NO,’ which applies to everyone.
 
 
NOTE: BGS reserves the right to perform background checks for sexual misconduct and to refuse or terminate membership based on its findings in this regard.
Interests:  
Expectations:  
 
If you are accepted for membership in BGS, you will be asked to sign this questionnaire confirming the information you have provided. The signed copy will become a part of your application for membership and membership file.