MEMBERSHIP Membership form coming soon… BLUELINE SHOOTING SPORTS (BSS) APPLICATION FOR RANGE MEMBERSHIPFirst Name:*Middle Initial: *Last Name:*Age: *Birthdate:*01020304050607080910111213141516171819202122232425262728293031 / JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember / 20162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119201919191819171916191519141913191219111910190919081907190619051904190319021901daymonthyearE-mail:*Address:* AddressAddress Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState / Province / RegionPostal / Zip CodePhone Number:* Area Code - Phone Number Emergency Contact Number* Area Code - Phone Number Emergency Contact Name:Are you a United States citizen?*YesNoPlace of Birth:If you work in Law Enforcement, please indicate the following:Shield:Agency:If you have a New York State Pistol/Revolver License, please indicate the following:License #:Exp.date:01020304050607080910111213141516171819202122232425262728293031 / JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember / 20162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119201919191819171916191519141913191219111910190919081907190619051904190319021901daymonthyearCounty of IssueSelect CountyWestchesterPutnamDutchessRocklandOrangeNew York CountyBroxQueensRichmondKingsOtherHave you ever been convicted of a crime?*YesNoNRA Membership #, if any:Exp.date01020304050607080910111213141516171819202122232425262728293031 / JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember / 20162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119201919191819171916191519141913191219111910190919081907190619051904190319021901daymonthyearI am applying for (check one): *Handgun MembershipLong Gun MembershipBLUELINE SHOOTING SPORTS (BSS) RANGE SAFETY RULESThe commands of the Range Safety Officer (“RSO”) employed by Blueline Shooting Sports (“BSS”) to supervise the range must be obeyed at all times. The Chief Range Safety Officer (“CRSO”) will settle all disputes.Please input your initials into each of the following lines if you comply.All firearms must comply with applicable New York State laws.*Firearms must be transported to and from the range in accordance with New York State laws; either concealed carry or in a locked carry bag/case. No exposure or uncasing of firearms is allowed in the parking lot, lobby or elsewhere on the premises other than the range proper*All ammunition must comply with applicable New York State laws. PROHBITED: black powder, steel core ammo (steel cased may be permitted), reloaded ammunition (remanufactured ammo may be permitted), AP, tracer or incendiary powder. In addition, for safety reasons the BSS RSO may examine and has sole discretion to prohibit the use of ammunition not purchased at BSS*No person shall discharge a firearm unless legally permitted to discharge that firearm in New York State.*Persons under the age of 12 are not permitted on the range at any time.*Persons under the age of 16 may only fire a long gun.*Persons older than 16 years but not yet 21 may only handle or fire a handgun while accompanied by an appropriatelyqualified NRA-certified instructor.*Persons older than 12 years but not yet 18 years must be accompanied at all times by an appropriately-qualified NRAcertified instructor OR a member of BSS fitting one of these categories: the parent, a court-appointed legal guardian, an accompanying guardian designated-in-writing by the parent or court-appointed legal guardian. Rules 5 and 6 still apply*Rules #4 through #7 shall apply to all persons and/or firearms notwithstanding any provisions of New York law permitting different age restrictions*Long guns capable of firing rounds greater than the ballistic rating of a .308Win or a 10ga slug are NOT permitted. No shot of any size or configuration may be used while firing any firearm. Long guns must be shouldered when fired. No rear pistol grips are allowed.*Muzzle loading firearms are not permitted on the range.*Drawing from the holster may be allowed at certain times at the sole discretion of the CRSO. The BSS RSO may suspend the right to draw from a holster at any time.*Any person under the influence of drugs or alcohol may NOT shoot. Anyone seeming to be under the influence of alcohol may be asked to take a breathalyzer test. Refusal to submit to, or failure of, a breathalyzer test, may result in termination of membership.*Always treat firearms as if loaded.*Always keep firearms pointed down range. Do not point firearms at anything you do not intend to shoot.*Always keep finger outside the trigger guard and up on the frame until ready to fire.*Always be aware of the target and what is beyond it*Eye protection that fully encloses the eye AND ear protection must be worn prior to entering the sally port and must be worn at all times while on the range.*Uncontrolled fire is not allowed. Shooters may fire only as rapidly as their ability permits to insure shots do not hit the walls, floor, overhead baffles, electronic target carrier systems, target supports or any other shooter’s target. The BSS RSO will disallow rapid fire that is detrimental to the facility and/or other shooters.*The BSS RSO commands must be obeyed at all times. In case of a dispute the decision of the BSS CRSO is final.*The BSS RSO may disallow firing against any target if such firing represents a danger to anyone on the range.*Persons witnessing what they believe to be a violation of safety rules must immediately report such to the BSS RSO. Horseplay, pranks and practical jokes are not permitted on the range at any time.*ANYONE AT ANY TIME MAY CALL FOR A CEASE FIRE! When a cease-fire is called for any reason, all persons MUST IMMEDIATELY stop shooting and follow all instructions given by the BSS RSO.*During a cease-fire, all persons on the firing line MUST put down and refrain from handling firearms and ammunition. Firearms must be placed pointing down range with actions open, magazines removed or cylinders open as applicable. Shooters are to remain off the line behind the red safety line until the BSS RSO clears shooting to resume.*If a firearm fails to fire, the shooter must keep the firearm pointed down range and wait a minimum of 30 seconds to ensure the perceived misfire does not become a hang fire. If the round does not go off, the shooter must raise a hand to request the assistance of the BSS RSO. At no time is the shooter to reload the misfired round and try to re-fire same. The round will be taken by the BSS RSO and placed in the dud bucket for proper disposal.*If the shooter experiences what may be called a “squib load”, the shooter must immediately stop shooting and raise a hand to request the assistance of the BSS RSO who will determine whether the firearm is safe to shoot.*Shooters must police their area at the end of their shooting session. The range squeegee may be used to place brass cases in the brass trough, or the spent brass within the shooter’s area may be taken. AT NO TIME MAY THE SHOOTER PICK UP BRASS THAT HAS GONE FORWARD OF THE SHOOTING BENCH. Receptacles for all other waste products will be located at either end of the firing line.*Shooters must be properly and respectfully dressed to access the range. No backward facing caps. No provocative or inciteful language on clothing. Attire that leaves bare skin exposed is NOT advisable and may be prohibited by the BSS RSO. This includes but is not limited to: tank tops or other shirts with gaping neck lines; low-hanging or baggy pants; “mini” shorts, dresses, skirts and other attire - male or female - leaving bare skin exposed; sandals, beach or other shoes that do not cover the feet. The BSS RSO may supply and/or require a cover shirt or change of clothes if attire presents a danger. Proper attire is at the sole discretion of the BSS CRSO.*Food, beverages, chewing gum or tobacco, mints, etc. are strictly prohibited on the range.*Cell phone use on the range is strictly prohibited. Personal calls and/or beeper responses must be placed OFF range.*NO AUDIO or VIDEO RECORDINGS ARE PERMITTED ON THE RANGE.*Shooters may not leave the range with a cased firearm that is loaded. Upon finishing a shooting session, the shooter must “show clear” to the RSO for all firearms used unless reholstering a concealed carry.*Smoking is prohibited throughout the building and inner courtyard. Please step away from the front door / sidewalk and into the parking area to smoke.*BLUELINE SHOOTING SPORTS (BSS) CERTIFICATION FORM FOR RANGE USEI am not under indictment in any court for a crime for which the judge could imprison me for more than one year. *I have never been convicted in any court of a crime for which the judge could have imprisoned me for more than one year, even if the judge issued a shorter sentence.*I am not a fugitive from justice.*I am not an unlawful user of, or addicted to, marijuana or any depressant, stimulant or narcotic drug, or any other controlled substance.*I have never been adjudicated mentally defective, nor have I ever been committed to a mental institution.*I have never been discharged from the Armed Forces under dishonorable conditions.*I am not an alien illegally in the United States.*I have never renounced my United States citizenship.*I am not subject to a court order restraining me from harassing, stalking or threatening an intimate partner or child of such partner.*I have never been convicted in any court of a misdemeanor crime of domestic violence*During the course of my membership, I agree to notify BSS of any change that affects the foregoing Certification.*BLUELINE SHOOTING SPORTS (BSS) MEMBER REGULATIONSThe Membership Application, Certification Form for Range Use, Release of Liability and Assumption of Risks Waiver, and the Rules and Regulations must be read and completed in entirety. Membership is granted at the sole discretion of Blueline Shooting Sports (“BSS”). False statements on the Membership Application or Certification Form for Range Use may be grounds for denial of membership or, if discovered after membership is granted, immediate termination of membership without refund of the unused portion. Members agree to complete a BSS Certification Form for Range Use and a Release of Liability and Assumption of Risks Waiver annually or as requested from time to time by BSS. Members agree to comply at all times with current and/or posted Rules and Regulations as in effect from time to time. Non-compliance with the Rules and Regulations, whether intentional or not, may be cause for termination of membership with or without refund of any unused portion at the sole discretion of BSS. The minimum age for a Handgun Membership is 21 years. A valid New York State Pistol/Revolver License is required for a Handgun Membership and must be presented each time a Member enters the facility with a handgun and/or upon request by BSS staff. NO ONE may handle or shoot a handgun at the facility without presentation of a valid New York State Pistol/Revolver License or a Law Enforcement ID. The minimum age for Long Gun Membership is 18 years. Applicants for Long Gun Membership must demonstrate proficiency. If not a United States citizen, applicant must present proof of compliance with applicable immigration and residency laws, and submit to a background check at the applicant’s expense. Junior Memberships are available for persons between the ages of 16 to 18 years. Junior Membership, if granted, will allow the Junior Member unsupervised long gun access. Junior Day Members must be accompanied by, and shoot in the same lane as, a BSS Member who is one of the following: the parent, a court-appointed legal guardian, or a guardian designated-in-writing by the parent or court-appointed legal guardian. Junior Day Members may also be on the range under the supervision of an appropriately-qualified NRA-certified instructor while taking a class. ALL Junior Members may ONLY handle or shoot handguns while under the supervision of an appropriately-qualified NRA-certified instructor. A child of a Member who is 12 years or older but not yet 16 years may accompany the Member onto the range for the purpose of learning about shooting. Unaccompanied minors may NOT be left unsupervised in the lobby. A child of a Member who is older than 16 years of age is NOT eligible to shoot at the range unless they become a Junior Member, purchase a Junior Day Membership, or are taking a class. A Release of Liability and Assumption of Risks Waiver must be signed for EVERY minor entering the range regardless of whether the minor is handling or shooting a firearm. BSS reserves the right to remove any such minor from the range at any time for any reason. More than one accompanying minor on the range at any given time is at the sole discretion of BSS. Non-Members may NOT accompany a Member onto the range. Exceptions to this rule may be made at the sole discretion of the BSS. Any non-Member allowed onto the range must sign the Release of Liability and Assumption of Risks Waiver: NO EXCEPTIONS! UNDER NO CIRCUMSTANCES MAY A NON-MEMBER HANDLE OR SHOOT ANY FIREARM. Observation windows may be available when the classroom is not in use. A Handgun Member whose New York State Pistol/Revolver License lapses will automatically become a Long Gun Member. Long Gun Members who obtain a valid New York State Pistol/Revolver License may convert to a Handgun Membership upon presenting a valid New York State Pistol/Revolver License to BSS. Range Members are encouraged to become members of the National Rifle Association (NRA). New range Members will receive one free hour of range time if they are or become an NRA member during their first year of range membership. Firearms can be dangerous. By entering the facility, a person assumes all risk of injury, damage or loss from the use or handling of firearms. BSS is not responsible for any such injury, damage or loss. Persons who cause injury, damage or loss to BSS or others through the use or handling of firearms shall indemnify BSS and hold it harmless from and against such injury, damage or loss, including but not limited to reasonable attorney fees. All fees are subject to change at any time at the sole discretion of BSS. Membership fees must be paid IN FULL prior to commencement of privileges. Annual calculation begins the day the membership is paid for. Annual calculation for Members who signed up prior to the range opening, will be the first day of the first month AFTER the range is open. Returned checks are subject to a $50 bounced check fee.If my application is approved, I agree to abide by the Range Safety Rules and the Member Regulations of Blueline Shooting Sports (“BSS”) as in effect from time to time (collectively, the “Rules and Regulations”). I have read in its entirety and understand the current version of the Rules and Regulations and agree to attend a brief orientation session. I further agree to complete and sign a Certification Form for Range Use and a Release of Liability and Assumption of Risks Waiver. PAYMENT IN FULL IS REQUIRED AT THE TIME OF APPLICATIONPlease print full name as signature:*SubmitReset"Submit" button will appear once all required form fields are completed.