YMCA Weight Loss Program

YMCA Weight Loss Program
The YMCA Weight Loss Program is an evidence-informed program designed to help people seeking a healthier weight achieve their goals by making small, modest changes to their daily behaviors, and forming sustainable healthy habits. The program focuses on realistic behavior change within the physical and mental aspects of weight management. This program is not a diet, instead participants are guided, supported and held accountable to reach their unique health goals. This program meeting weekly for 60-minutes for 13-weeks and is offered both in-person and online.

Completing this form does not guarantee enrollment. A YMCA Care Coordinator will contact you to discuss the program, your health goals and support getting connected to a program offering.
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Are you okay with receiving text messages regarding your interest in this program? (Data messaging rates may apply)
Email
example@example.com
Todays Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Age
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
NOTE: You must be 18 years or older to participate in the Y Weight Loss Program.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What is your current weight (pounds)?
What is your height?
How did you hear of the Weight Loss Program?
Are you currently an active YMCA of Pierce and Kitsap Counties member?
Please select your preferred YMCA Location for programming?
Please select your preferred time for programming
Are you a Spanish Speaker?
Should be Empty: