Online Screening Questionaire for Singles

Applying as:                          click here  to apply as a couple
State of Residence:  
Phone Number:     
Email Address:  
Best way to reach you?

Referring Member:  
Referring Member Number:  
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:

I am at least twenty-one (21) years of age and applying as a single in the lifestyle and not married to anyone else. (Married females/males are not eligible to apply as singles.)
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.
Level of Experience:    
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.