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BE AWESOME BE STRONG LLC

RED LIGHT THERAPY (PHOTOBIOMODULATION) INFORMED CONSENT & LIABILITY WAIVER
Facility Location: 160 Old Farm Rd, Suite C-D, Amherst, MA 01002
Phone: 413.345.5317


1. ASSUMPTION OF RISK & NATURE OF SERVICES

Red Light Therapy (also known as Photobiomodulation or PBM) utilizes specific wavelengths of low-level red and near-infrared light designed to support circulation, cellular energy, muscle recovery, and tissue relaxation. Red Light Therapy is a non-invasive service provided for general wellness, athletic recovery, and cosmetic support.


I understand and acknowledge that:


  • Red Light Therapy is not a substitute for professional medical advice, diagnosis, or treatment.
  • Be Awesome Be Strong LLC staff are not medical doctors, and no service offered should be construed as medical care, treatment, or diagnosis.
  • While generally considered safe, risks associated with low-level light therapy may include temporary mild skin redness, eye fatigue, lightheadedness, or mild discomfort in light-sensitive individuals.


2. CONTRAINDICATIONS & HEALTH ACKNOWLEDGMENT

For your safety, certain medical conditions and treatments require caution or medical clearance prior to using Red Light Therapy equipment.


  • Pregnancy: If you are pregnant. You should discuss risks and benefits of red light therapy with your healthcare provider and receive clearance for short duration treatments.


By signing below, I certify that I DO NOT have any of the following conditions, OR that I have received explicit clearance from a licensed healthcare provider to participate:


  • Pregnancy: I am not currently pregnant or suspect I may be pregnant OR are pregnant and received clearance from your healthcare provider.
  • Photosensitivity / Medications: I am not taking medications known to induce photosensitivity or light sensitivity (including, but not limited to, certain antibiotics, accutane, diuretics, or chemotherapy agents).
  • Active Malignancy / Cancer: I do not have active cancerous lesions or tumors.
  • Eye Conditions: I am aware of the light intensity and agree to wear protective eye goggles provided by the facility at all times during the session.
  • Epilepsy / Seizure Disorders: I am not prone to light-triggered seizures or light-induced migraines.


If you checked or suspect any of the conditions above, you must inform Be Awesome Be Strong LLC staff prior to your session.


3. CLIENT RESPONSIBILITIES & RULES OF USE

I agree to strictly adhere to all instructions, warnings, and guidelines provided by Be Awesome Be Strong LLC staff, including but not limited to:


  1. Eye Protection: Protective eyewear supplied by the facility must be worn for the entire duration of the session.
  2. Session Limits: I will not exceed the recommended time limits per session (typically 10 to 20 minutes) established by staff or equipment guidelines.
  3. Hygiene & Equipment Care: I will follow all sanitization protocols before and after using the equipment.


4. WAIVER AND RELEASE OF LIABILITY

In consideration of being permitted to use the Red Light Therapy equipment and services at Be Awesome Be Strong LLC, I, for myself, my heirs, personal representatives, and assigns, do hereby:


  1. RELEASE, WAIVE, AND FOREVER DISCHARGE Be Awesome Be Strong LLC, its owners (including Beth Anne Moonstone), operators, officers, employees, coaches, independent contractors, and agents from any and all liability, claims, demands, actions, or causes of action arising out of or related to any loss, damage, or injury (including death) that may be sustained by me while using the Red Light Therapy equipment or participating in recovery services.
  2. COVENANT NOT TO SUE Be Awesome Be Strong LLC for any claims arising from the normal and intended use, or accidental misuse, of the Red Light Therapy equipment.
  3. INDEMNIFY AND HOLD HARMLESS Be Awesome Be Strong LLC from any loss, liability, damage, or costs (including legal fees) that may incur due to my participation in these services, whether caused by negligence or otherwise, to the fullest extent permitted by Massachusetts law.


5. ACKNOWLEDGMENT OF UNDERSTANDING

I have read this Informed Consent & Liability Waiver carefully and fully understand its terms. I understand that I am giving up substantial legal rights, including the right to sue. I acknowledge that I am signing this agreement freely and voluntarily, and intend my signature to be a complete and unconditional release of all liability to the greatest extent allowed by law.



Please select who will be participating...
AdultMinor
First Participant's Name
First Name*
Middle Name
Last Name*
Phone*
First Participant's Date of Birth*
Date of Birth
First Participant's Signature*
Parent or Guardian's Email Address
Email*
Confirm Email*
Emergency Contact
First Name*
Last Name*
Emergency Contact's Phone Number*
Parent(s) or Court-Appointed Legal Guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name
First Name*
Middle Name
Last Name*
Relationship*
Phone*
Parent or Guardian's Date of Birth*
Date of Birth
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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