Samskara Yoga Duck Army







Welcome to your community with Samskara Yoga & Healing!  Please read this document carefully.  It affects your legal rights in the event of an injury or other loss.  It must be signed by all adult (eighteen years and older) participants and by a parent or guardian of a minor participant.  The parent or guardian agrees to these provisions for himself or herself and on behalf of the minor participant.


Activities, Risks and Responsibilities


Yoga, Aerial Yoga, Barre, Zumba, and other activities hereafter known as PROGRAMS.

Our programs are designed to foster awareness of the mind-body connection and promote physical, mental, emotional and spiritual growth.  Samskara Yoga & Healing, LLC hereafter known as SYH.


Programs include physical movements as well as an opportunity for relaxation, stress re-education and relief of muscular tension.  Participation in programs includes, but is not limited to, participation in meditation techniques, yogic breathing techniques, and performing various movement.  Programs are designed to exercise every party of the body—stretching and toning the muscles and joints, the spine and the entire skeletal system. They also work on the internal organs, glands and nerves.  Programs incorporate sustained stretching to strengthen muscles and increase flexibility. Our Programs are not a substitute for medical attention, examination, diagnosis or treatment. Programs are not recommended and are not safe under certain medical conditions. 


Programs may be conducted outdoors, and participants must be aware of the hazards of slippery and uneven footing, falling limbs and branches, insects, animals and plants and exposure to extreme or inclement weather. Staff and participants may, in spite of instruction and training, act or fail to act in a reasonable manner, and cause an injury or other loss. These and other risks may result in property damage, physical and emotional injury and even the remote possibility of death.  As is the case with any physical activity, the risk of injury, even serious or disabling, is always present and cannot be entirely eliminated without adversely impacting the value of the activity. 


My signature acknowledges that I understand these risks, that I have personal responsibility for my own well-being and that I will progress at my own pace in programs.  I will inform the instructor of any physical, mental or medical condition that might impact my ability to participate fully in the class. If I experience any pain or discomfort, I will listen to my body, adjust the posture and ask for support from the instructor.  I will continue to breathe smoothly. If at any point I feel overexertion or fatigue, I will respect my body’s limitations and I will rest before continuing. 


My signature also verifies that I am physically fit to participate in the programs offered and a licensed medical doctor has verified my physical condition for participation in this type of class.  If I am pregnant or become pregnant or am post-natal, my signature verifies that I am participating in programs with my doctor’s full approval. I realize that I am participating at my own risk. I affirm that I alone am responsible to decide whether to participate in the programs


Assumption of Responsibilities and Risks


By signing my name below, I acknowledge that participation in Programs exposes me to a possible risk of personal injury and assume the personal responsibility described above and all risks of participating, inherent and otherwise and whether or not described above.  I am fully aware of these risks. If the participant is a minor, I have discussed the activities and risks and personal responsibilities with him or her and the minor participant assures me that he or she understands them and wishes to participate nevertheless, and I consent to such participation.  


Agreement of Release and Indemnity


To the fullest extent allowed by the laws of the Commonwealth of Virginia, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors and assigns as follows: I (a) irrevocably WAIVE, RELEASE, AND DISCHARGE FROM ANY AND ALL LIABILITY for my death, disability, personal injury, property damage, property theft or actions of any kind which hereafter may occur to me (or the minor participant), including my traveling to and from Programs, Samskara Yoga & Healing, LLC, and its directors, officers, employees, volunteers, representatives and agents; and (b) INDEMNIFY AND HOLD HARMLESS the entities or persons mentioned in this paragraph (the “Released Parties”) as to any and all liabilities or claims (including costs and attorneys’ fees) made as a result of participation in the programs, whether caused by the negligence (but not the gross negligence or willful misconduct) of the Released Parties or otherwise.  The only exception to this Agreement of Release and Indemnity is a claim of loss that arises solely (that is, no other factor – human, environmental or otherwise – contributed to the loss) from a negligent act or omission of any one or more of the Released Parties. This exception shall apply only if participant has complied in full with all personal responsibilities and obligations set forth above.


My signature further acknowledges that I shall not now or at any time in the future bring any legal action against Samskara Yoga & Healing, LLC or any of the other Released Parties; and that this waiver is binding on me, my heirs, my spouse, my children, my legal representatives, my successors and my assigns.  




In the event of an emergency, injury, accident or illness during Programs, I give permission to Samskara Yoga & Healing, LLC to provide or obtain such medical treatment as it deems appropriate.  I understand that Samskara Yoga & Healing, LLC will attempt to contact the parent or guardian of a minor participant in such event, as circumstances allow. I understand that I am responsible for all medical expenses incurred by or on behalf of me or the child.


If any portion of this agreement is deemed unenforceable by a court of competent jurisdiction, the remainder shall nevertheless remain in force and effect. 


Any dispute between participant or parent/guardian and a Released Party must be resolved in accordance with the laws of the Commonwealth of Virginia (without reference to its principles of conflicts of law), and a suit against a Released Party must be brought in Loudoun County, Virginia. I agree, for myself and for the child, to the jurisdiction of that court.


 I have read and understand all materials provided to me describing the Programs, including this agreement and agree that I, and the minor participant, will abide by these terms.  I am aware that this agreement may include the surrender of certain legal rights and I sign it voluntarily.

LATE CANCEL POLICY: If you cancel a class less than 1 hour (60 minutes) before the class begins, your Class Pass or Day Pass will not be refunded and you will not be able to transfer it to a different class and/or day.

EARLY CANCEL POLICY: If you cancel a class more than 1 hour before it is scheduled to begin, you will retain the rights to your Class Pass or Day Pass and may use it at any other time (through its original expiration date).

UNLIMITED MONTH CLIENTS OR PROMO CLIENTS may have their accounts placed on hold for violating class cancellation policies. If no-shows or late cancellations are a recurring problem, Samskara Yoga & Healing reserves the right to charge a fee equivalent to a one-month unlimited membership and require the member to pay the current drop-in rate for future classes for 30 days.

Please note, these fees are preventative measures rather than penalties. No-shows and no-cancels limit other members from participating in classes and enjoying the community aspect of our Practice Center.

All No Show/No Cancel incidents will incur an automatic Drop-in fee charge. No Exceptions.

SINGLE CLASS DROP IN/DAY PASS: If you purchased a Single Class Drop-In or Day Pass your drop-in class pass will be forfeited and your Day Pass will be forfeited for the remainder of the calendar day. No additional fees will be charged but you will not be able to use the Drop-in or Day Pass at a later time. A missed class cannot be transferred or used for another date or time. No Exceptions.

COMMUNITY CLASSES: These classes are free to attend and we appreciate having an understanding of how many students will be at each class. This helps us know how many mats to bring or other considerations. We cannot charge a fee for a no show, but we will suspend your account from further reservations until our cancellation policy is acknowledged via email.


1) This Samskara Yoga & Healing AUTO DRAFT AGREEMENT is a one (1) year commitment. Six (6) month minimum.

2) A valid credit /debit card on file in the name of the person authorizing auto draft is required. A $50 charge will be assessed for credit/debit card auto draft rejected due to insufficient funds or expired cards.

3) The auto draft payment will be charged every 30 days.

4) First-month payment is required for sign up and is NOT refundable and non-transferable.

5) Months in which a student does not attend any class will not be refunded under any circumstances.

6) The person authorizing auto draft may pause the auto draft one (1) month out of every year, or for two (2) weeks twice a year. During this time a student will not be able to attend classes without payment. Requests to pause the auto draft will only be accepted if received by email to info@samskarayogava.com 30 days in advance. The person authorizing the auto draft will be notified via email from Samskara Yoga & Healing with regard to auto draft status.

7) For cancellation: the authorized payer must notify Samskara Yoga & Healing at least 30 days prior to next auto draft (billing date) in writing or via email to info@samskarayogava.com. We do not accept phone, verbal, or voice mail cancellations. Cancellations will only be valid once Samskara Yoga & Healing staff confirms the cancellation via email (iinfo@samskarayogava.com). If you do not hear back from Samskara Yoga & Healing within 3 business days, it means your request was not received or was sent to an incorrect email address and you will be required to resend. Cancellations can only be processed after they have been sent to info@samskarayogava.com.

8) If the person authorizing the auto draft cancels this agreement for any reason before the end of the minimum number of months, person authorizing auto draft agrees to pay an early cancellation fee equivalent to one month of unlimited yoga ($139) and authorizes Samskara Yoga & Healing to charge the credit/debit card on file. A 1-1/2 % LATE FEE will be applied to any balance not paid over 30 days old.

9) If the person authorizing auto draft and the student are not the same person, both persons must sign this agreement.

10) All rates and fees are final upon agreement.

These policies are subject to change and will be updated periodically.

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