6 Week Starter Request Form

The 6 Week Starter is a complementary series of appointments with you and a YMCA Fitness Coach. We will help establish your personal wellness goals, counsel on your nutritional habits, and coach you through the strength equipment. Research shows that support and motivation are two important factors that lead to individual success.

First Name:
Last Name:

I prefer to be contacted via the following:

At which YMCA would you like to complete your 6 Week Starter program?:

Please contact me at these days: (check the days you are available)
Monday Tuesday Wednesday Thursday Friday Saturday Sunday

Please contact me at these times: (check the times you are available)
5-9 AM 9-12 NOON 12-4 PM 4-8 PM

Please enter both words/numbers that you see below in the box - this helps us prevent "spam" responses to this form - thanks!