5th Quarter Sports Sign-In Sheet and Liability Waiver
Please review the 5th Quarter Sport Liability Waiver, and then complete this form in its entirety prior to participating in any 5th Quarter Sporting Event. Required fields are marked with an asterisk.

5th QUARTER SPORTS
RELEASE OF LIABILITY
READ CAREFULLY - THIS AFFECTS YOUR LEGAL RIGHTS

In exchange for participation in the activity of any sports or social activity run by 5th Quarter Sports organized by 5th Quarter Sports ("5th Quarter"), of 5395 Napa Rd #402, San Diego, California, 92110 and/or use of the property, facilities and services of 5th Quarter, I agree for myself and (if applicable) for the members of my family, to the following:

1. I agree to observe and obey all posted rules and warnings, and further agree to follow any oral instructions or directions given by 5th Quarter, or the employees, representatives or agents of 5th Quarter.

2. I recognize that there are certain inherent risks associated with the above described activity and I assume full responsibility for personal injury to myself and (if applicable) my family members, and further release and discharge 5th Quarter for injury, loss or damage arising out of my or my family's use of or presence upon the facilities of 5th Quarter, whether caused by the fault of myself,
my family, 5th Quarter or other third parties.

3. I agree to indemnify and defend 5th Quarter against all claims, causes of action, damages, judgments, costs or expenses, including attorney fees and other litigation costs, which may in any way arise from my or my family's use of or presence upon the facilities of 5th Quarter.

4. I agree to pay for all damages to the facilities of 5th Quarter caused by my or my family's negligent, reckless, or willful actions.

5. Any legal or equitable claim that may arise from participation in the above shall be resolved under California law.

I HAVE READ THIS DOCUMENT AND UNDERSTAND IT. I FURTHER
UNDERSTAND THAT BY SIGNING THIS RELEASE, I VOLUNTARILY
SURRENDER CERTAIN LEGAL RIGHTS

First Name
Your answer
Last Name
Your answer
E-Mail Address
Your answer
Phone Number
Your answer
Gender
Date of Birth
Your answer
Zip Code
(This helps us figure out where to host events!)
Your answer
Sport
(The one you are about to play with us)
How did you hear about 5th Quarter Sports, or specifically, this event?
I have read the 5th Quarter Sports Liability Waiver and agree to its terms and conditions.
Required
I give 5th Quarter Sports the right to take my picture during any 5th Quarter sports or social event, and to use my image in any and all 5th Quarter Sports promotional materials.
If for any reason you do NOT want your image used, please make the 5th Quarter staff aware of this request before you participate.
Today's Date
Your answer
Emergency Contact Information
This section is REQUIRED for players under 18 years of age, and should reflect the contact information of their parent or guardian. This section is optional for players 18 years or older, but will allow us to keep a contact on file in case of emergency. Your emergency's contacts information will not be used by 5th Quarter Sports for any other purpose.
Emergency Contact Full Name
Your answer
Emergency Contact Phone Number
Your answer
Emergency Contact E-Mail Address
Your answer
Emergency Contact Relationship to Player
Your answer
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