YMCA Fitness Assessment Form

Name:
Contact Information:
YMCA Branch
What are your goals? Please check all that apply:
Do you have any medical conditions or injuries that could affect your ability to exercise?
What gym services are you interested in? Please check all that apply.
Would you be interested in any of the following services for yourself or your family?
Would you be interested in any of the following Community Health programs for yourself or your family?
Which days of the week are you available? Please check all that apply.
Which times of day are you available? Please check all that apply.