YMCA Wellness & Fitness Interest Form
Eau Claire South YMCA
Are you looking for guidance in your fitness journey? Whether you need help with equipment, a wellness consultation, or personal training, we’re here to support you!
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Preferred method of contact: (Check all that apply)
Phone
Email
Text
What are you interested in? (Choose one) Please note that multiple selections may require multiple appointments. We recommend starting with 1 then talking to your trainer about setting up additional services
Wellness Consultation - Discuss your health and fitness goals, lifestyle, and strategies for success.
Equipment Orientation – Learn how to use YMCA equipment safely and effectively.
EGYM Onboarding – Get onboarded and learn how to use the EGYM equipment safely and effectively.
Personal Training Consultation – Get individualized coaching and training tailored to your goals.
What are your goals? (Choose all that apply)
Build Strength
Improve Endurance
Weight Loss/Management
Increase Flexibility/Mobility
Learn Proper Exercise Techniques
General Wellness
Learn How to Use the Equipment
Discuss Goals with a Knowledgeable Wellness Staff Member
What are you looking to get out of your sessions and is there anything we should know?
Please briefly describe your goals, concerns, or areas you'd like to focus on.
What is your availability? (Choose all that apply)
Early Morning (5-8 AM)
Morning (8 AM-12 PM)
Afternoon (12 -4 PM)
Evening (4-6 PM)
Which days of the week work best for you? (Choose all that apply)
Monday
Tuesday
Wednesday
Thursday
Friday
Do you have a preference in a trainer?
Male
Female
No Preference
Next Steps:
Our Healthy Living Team, will be in touch with you to schedule your session. If you have any questions, feel free to reach out to our Member Engagement Director, Haili Carlson, 715-861-8160 or hcarlson@ymca-cv.org.
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