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Contact Information:
Email
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Alabama
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ZIP/Postal Code
YMCA Branch
Coppell Family YMCA
Cross Timbers Family YMCA
Frisco Family YMCA
Grand Prairie Family YMCA
J.E.R. Chilton YMCA at Rockwall
Lake Highlands Family YMCA
Mckinney Family YMCA
Moody Family YMCA
Moorland Family YMCA at Oak Cliff
Park South Family YMCA
Plano Family YMCA
Richardson Family YMCA
Semones Family YMCA
T. Boone Pickens YMCA
Waxahachie Family YMCA
White Rock YMCA
What are your goals? Please check all that apply:
Weight Loss
Strength
Sports Performance
Rehab/Recovery
Flexibility/Mobility
Mental Wellness
Other…
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Do you have any medical conditions or injuries that could affect your ability to exercise?
No
Yes, please explain:
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What gym services are you interested in? Please check all that apply.
Strength Machines
Cardio Machines
Personal Training
Group Exercise
Would you be interested in any of the following services for yourself or your family?
Sports (Youth, Adults, Special Needs, etc.)
Teen Programs (Youth & Government, Teen Camp)
Education (Preschool, Afterschool, STEM)
Swim Lessons
Child Watch
Special Events (Turkey Trot, Community Events etc.)
Summer Camp
Adventure Guides
Would you be interested in any of the following Community Health programs for yourself or your family?
Diabetes Prevention (year-long program to learn healthy habits in small group sessions)
Get Up and Go (10-week weight management program for children and their parents giving the tools to develop and maintain healthy habits)
LIVESTRONG (12-week physical activity program for cancer survivors)
FIT for Health (free 11-week healthy lifestyle program for parents and their children to learn fun physical activities, healthy habits, calorie goals and self-monitoring, as well as positive parenting styles and tips)
Blood-Pressure Self-Monitoring Program (four-month program focuses on regulated home self-monitoring of one’s blood pressure)
Kamp K’aana (introduces children, ages 10-14, to the tools they need to learn and love a healthy lifestyle, while offering the fun of an overnight summer camp experience!)
Which days of the week are you available? Please check all that apply.
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Which times of day are you available? Please check all that apply.
5:30 AM-9:30 AM
9:30 AM-1:30 PM
1:30 PM - 5:30 PM
5:30 PM - 9:30 PM
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