Form FDACS-10300 "Health Studio Registration Application" - Florida

Form FDACS-10300 is a Florida Department of Agriculture and Consumer Services form also known as the "Health Studio Registration Application". The latest edition of the form was released in March 1, 2018 and is available for digital filing.

Download an up-to-date fillable Form FDACS-10300 in PDF-format down below or look it up on the Florida Department of Agriculture and Consumer Services Forms website.

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Download Form FDACS-10300 "Health Studio Registration Application" - Florida

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FLORIDA DEPARTMENT OF AGRICULTURE AND
CONSUMER SERVICES
ADAM H. PUTNAM
COMMISSIONER
HEALTH STUDIO
REGISTRATION APPLICATION
Sections 501.012 – 501.019, Florida Statutes
Rule 5J-4.004, Florida Administrative Code
FLORIDA DEPARTMENT OF AGRICULTURE AND
CONSUMER SERVICES
ADAM H. PUTNAM
COMMISSIONER
HEALTH STUDIO
REGISTRATION APPLICATION
Sections 501.012 – 501.019, Florida Statutes
Rule 5J-4.004, Florida Administrative Code
Florida Department of Agriculture and Consumer Services
Health Studio Registration Application
Table of Contents
Filing Instructions
Page II
Pages II – III
Application Checklist
Contract Requirements
Page III - V
Pages 1 – 3
Registration Application
Pages 4 – 5
Surety Bond
Pages 6 – 7
Irrevocable Letter of Credit
Certificate of Deposit Assignment Form
Page 8
Pages 9 – 10
Sample Escrow Agreement Language
FDACS-10300 Rev. 03/18
Page I of V
REGISTRATION REQUIREMENTS
Florida Law requires all health studios, which operate in the state of Florida, to annually obtain a certificate from the Florida
Department of Agriculture and Consumer Services (FDACS). The annual registration fee is $300 and is required of each
health studio location. As part of the registration requirement, certain health studios must post a $25,000 security with the
department to satisfy claims that may arise as a result of violations of Florida law. In addition, you must show proof of
registration from the department prior to obtaining or renewing your local business tax receipt.
If you are subject to the security requirements of the law, you must maintain a surety bond in the sum of $25,000. In lieu of
maintaining a surety bond, you may, subject to approval by the department: (1) secure an irrevocable letter of credit from any
foreign or domestic bank; or (2) furnish a guaranty agreement, which is secured by a certificate of deposit. Please see s.
501.016, F. S., for security exemptions.
MILITARY FEE WAIVER FOR INITIAL REGISTRATION
The department shall waive the initial registration fee for an honorably discharged veteran of the United States Armed Forces,
the spouse of such a veteran, or a business entity that has a majority ownership held by such a veteran or spouse if the
department receives FDACS-10300, Health Studio Registration Application, Rev. 03/18 , FDACS-10991, Military Veteran Fee
Waiver Request, Rev. 07/17, and required documentation within 60 months after the date of the veteran’s discharge from any
branch of the United States Armed Forces. FDACS-10991, Military Veteran Fee Waiver Request, Rev. 07/17, is incorporated
by reference in Rule 5J-26.001, F.A.C. Please see s. 501.015(2), F.S., for waiver qualifications.
APPLICATION CHECKLIST AND INSTRUCTIONS
Item #1
Provide the name of the heath studio.
Item #2
Provide the physical street address for the health studio. Include the suite, room, or other unit number. If the mailing
address (i.e. a generally used post office box) is different from the health studio’s street address, provide that address as
well.
Item #3
You must provide the telephone number, including the area code, for the health studio. Also, provide the fax number, email
address and website.
Item #4
Provide the legal name, address, telephone number, fax number, email address and website of the owner.
Item #5
Please select the type of business organization for which you are registering.
Item #6
Provide the applicant’s federal employer identification number. Note: Taxpayers can obtain an EIN immediately by
calling the IRS Business and Specialty Tax Line (800-829-4933).
Item #7
Provide the name and address of each direct or beneficial owner and if a corporation, all corporate officers, and directors.
[s. 501.015(1), F.S.]
Item #8
Select the type of security that is provided and provide the requested documentation, OR select the security provision that is
applicable and provide the requested documentation.
[s. 501.016, F.S.]
FDACS-10300 Rev. 03/18
Page II of V
OTHER REQUIRED DOCUMENTS AND FEES
In order to process your application as quickly as possible, and avoid costly delays, please verify that all items
listed below are included prior to sending:
Completed registration application.
$300 fee for each location (Make check or money order payable to FDACS.) All fees are nonrefundable.
Copy of membership contract to be used by this location.
Original copy of applicable bond, irrevocable letter of credit, or guaranty agreement and security.
Mail to:
FDACS
Health Studio Program
PO Box 6700
Tallahassee, FL 32314-6700
SECURITY REQUIREMENTS
Unless exempt pursuant to law, each health studio must post an original security instrument in the amount of $25,000 with
the Florida Department of Agriculture and Consumer Services. A security instrument may be in the form of a surety bond,
an irrevocable letter of credit, or a guarantee agreement secured by a certificate of deposit.
If the health studio is claiming an exemption from the security requirement, indicate which exemption is being claimed, and
provide supportive documentation.
In the event the business is not yet in operation and is conducting pre-opening sales, you must provide the department with
a copy of the escrow account, if established, which would contain all funds received for future consumer services sold prior
to full operation of the health studio location and specify a date certain for opening, pursuant to s. 501.016(7), F.S.
CONTRACT GENERAL REQUIREMENTS
GENERAL REQUIREMENTS
The buyer should be provided with a written contract, which must include the name, address, and primary place of
business of the health studio.
The contract must conform to all the requirements for future health studio services contracts specified in ss.
501.012-501.019 and must specify in the terms of the contract the charges to be assessed for those health studio
services.
Health studio registration number needs to be on the membership contract. If this is a new studio a space can be
left to indicate where the number will go once assigned. Provision may read: “(Studio name) is registered with the
State of Florida as a Health Studio. Registration No. is HS ______.”
CONSUMER PROTECTION CLAUSES
Each contract for the sale of future health studio services which is paid for in advance or which the buyer agrees to pay for
in future installment payments shall be in writing and shall contain, contractual provisions to the contrary notwithstanding, in
immediate proximity to the space reserved in the contract for the signature of the buyer, and in at least 10-point boldfaced
type, language substantially equivalent to the following:
FDACS-10300 Rev. 03/18
Page III of V
A. The contract provides for the penalty-free cancellation of the contract within 3 days, exclusive of holidays and
weekends, of its making, upon the mailing or delivery of written notice to the health studio, and refund upon such
notice of all moneys paid under the contract, except that the health studio may retain an amount computed by
dividing the number of complete days in the contract term or, if appropriate, the number of occasions health studio
services are to be rendered into the total contract price and multiplying the result by the number of complete days
that have passed since the making of the contract or, if appropriate, by the number of occasions that health studio
services have been rendered. A refund shall be issued within thirty (30) days after receipt of the notice of
cancellation made within the 3-day provision.
[s. 501.017(1)(a), F.S.]
B. The contract provides for the cancellation and refund of the contract if the contracting business location of the
health studio goes out of business, or moves its facilities more than five (5) driving miles of the business location
designated in the contract and fails to provide, within 30 days, a facility of equal quality located within five (5) driving
miles of the business location designated in the contract at no additional cost to the buyer.
[s. 501.017(1)(b)1, F.S.]
C. The contract provides that notice of intent to cancel shall be given in writing to the health studio. The notice of
cancellation from the consumer terminates automatically the consumer's obligation to any entity to whom the health
studio has subrogated or assigned the consumer's contract. If the health studio wishes to enforce the contract after
receipt of the notice, it may request the department to determine the sufficiency of the notice.
[s. 501.017(1)(b)2, F.S.]
D. The contract provides that if the department determines that a refund is due the buyer, the refund shall be an
amount computed by dividing the contract price by the number of weeks in the contract term and multiplying the
result by the number of weeks remaining in the contract term. The business location of a health studio may not be
deemed out of business when temporarily closed for repair and renovation of the premises:
1. Upon sale, for not more than fourteen (14) consecutive days; or
2. During ownership, for not more than seven (7) consecutive days and not more than two (2) periods of
seven (7) consecutive days in any calendar year.
A refund shall be issued within 30 days after receipt of the notice of cancellation made pursuant to this paragraph.
[s. 501.017(1)(b)3, F.S.]
E. The disclosure statement shall include a provision advising the buyer to contact the department for information
within sixty (60) days should the health studio go out of business.
[s. 501.017(1)(c), F.S.]
F. The contract provides for the cancellation of the contract if the buyer dies or becomes physically unable to avail
himself or herself of a substantial portion of those services which the buyer used from the commencement of the
contract until the time of disability, with refund of funds paid or accepted in payment of the contract in an amount
computed by dividing the contract price by the number of weeks in the contract term and multiplying the result by
the number of weeks remaining in the contract term. The contract may require a buyer or the buyer's estate
seeking relief under this paragraph to provide proof of disability or death. A physical disability sufficient to warrant
cancellation of the contract by the buyer is established if the buyer furnishes to the health studio a certification of
such disability by a physician licensed under Chapter 458, 459, 460, or Chapter 461 provided the diagnosis or
treatment is within the physician’s scope of practice. A refund shall be issued within thirty (30) days after receipt of
the notice of cancellation made pursuant to this paragraph.
[s. 501.017(1)(d), F.S.]
G.
The initial contract will not be for a period in excess of thirty-six (36) months and thereafter shall only be renewable
annually. A renewal contract may not be executed and the fee therefore paid until sixty (60) days or less before the
previous contract expires.
[s. 501.017(1)(e), F.S.]
1. IF you sell a single contract for thirty (30) days or less, without any option or other condition which establishes
any right or obligation of a member beyond the thirty (30) day period then this provision should read as follows:
The initial contract will not be for a period in excess of thirty (30) days. A new contract may not be executed
and the fee therefore paid until the preceding contract expires.
2. IF you sell SESSIONS in this manner then the contract must ALSO indicate that ALL sessions must be used
within thirty (30) days.
H.
The contract provides that if the health studio requires a buyer to furnish identification upon entry to the facility and
as a condition of using the services of the health studio, the health studio shall provide the buyer with the means of
such identification.
[s. 501.017(1)(f), F.S.]
FDACS-10300 Rev. 03/18
Page IV of V
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