Sycamore Island Guest Liability Waiver
I confirm that I have been advised of and am aware of the many risks and dangers of swimming in and using a canoe, kayak, paddleboard, or other watercraft upon the Potomac River (specifically including the extreme danger of venturing near the Little Falls Dam). These include, but are not limited to, accidents relating to putting watercraft into the Potomac, slips and falls, overturning of watercraft, loss of balance, collision with and entrapment by objects in the Potomac, hypothermia, inclement weather, encounters with animals, and activities of other participants.  I acknowledge that I have been advised to wear an approved personal flotation device while engaged in water activities and to carry other safety equipment.  I confirm that I will not use any watercraft unless I am familiar with it and understand appropriate safety precautions. I further confirm that I understand there are other risks associated with the use of the Sycamore Island Club’s facilities, including but not limited to swings, zip-lines, and stairs.  Knowing the risks and dangers necessarily involved in swimming in and venturing upon the Potomac River in such watercraft, knowing that unexpected and foreseen dangers may arise during such activity, as well as the risks associated with use of the Sycamore Island Club’s facilities, I voluntarily assume all risks of death or injury to my person and my property that may be incurred in connection with or as a result of any activity I undertake on Sycamore Island and in the Potomac.

In consideration of the permission granted to me to enter the Club premises, to swim in the Potomac, and to use a canoe, kayak, or other watercraft belonging to the Club, or to launch such a watercraft from Club premises, I do hereby for myself, my heirs, administrators and assigns, release, remise and discharge the Club and its officers, directors, members, employees, and agents of, from all liability or claims that may arise as a result of my activities on the Club premises or the Potomac River or during or as a result of my use of the Club, its facilities, or any Club watercraft or watercraft launched from the Club premises, whether due to negligence or any other fault.

Children under the age of 15 are not permitted on the Island without a parent or guardian, who is solely responsible for their safety and conduct.  Parents and guardians hereby expressly acknowledge the foregoing risks and dangers, and agree to the above-referenced conditions, on behalf of their children.  Children between the ages of 15 and 18 may enter Club Premises if their parent or guardian has executed a Parental Liability Release/Waiver of Claims form (available on the Sycamore Island website or from the Island caretaker) on their behalf.
Sign in to Google to save your progress. Learn more
Email *
By typing your full name below, you agree that you have read and understand the foregoing liability release and waiver of claims. In witness thereof, I have hereunto set my hand and seal. (Type full name below) *
By typing your full name below, you agree that you have read and understand the foregoing liability release and waiver of claims. In witness thereof, I have hereunto set my hand and seal. (Type full name below) *
Clear selection
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy