Enhance Fitness Interest Form

Enhance Fitness Interest Form
Enhance Fitness is an evidence-based program designed to support individuals living with arthritis or at risk for falling. This 16-week exercise program meets 3 days a week for 60 minutes at a time. Participants are guided through low impact cardio and strength exercise focusing in stability, strength and endurance. All physical movements can be modified to meet your individual unique needs. If you want to learn more about this program, please take a moment to fill out the below information.

Please note this is to share your interest in the program, it does not mean you are enrolled. A YMCA staff member will contact you (via phone and/or email) to discuss the program in more detail and support your enrollment into this registration based program. Eligibility check required for program enrollment.
Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Are you okay with receiving text messages regarding your interest in this program? (Data messaging rates my apply)

YesNo
DOB

MonthDayYear
Date
Email*
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
County *
Please select your age range
Have you been diagnosed with arthritis?

Yes, self-diagnosedYes, diagnosed by a medical professionalNo
Have you been cleared by a medical professional to engage in physical activity?

YesNo
Have you had a fall in the past and/or are you at risk for falls (unsteady, balance concerns, etc)?

Yes, I've had a fall and I'm at risk for future fallsI haven't fallen but I am at risk of fallingI haven't had a fall and I am not at risk of falling
What's your current physical activity level?

Not very active (mostly sedentary)Somewhat active (chores around the house, short walks, etc)Active (group exercise classes, hikes, etc)
How did you hear of Enhance Fitness?
Are you a current member of the YMCA of Pierce and Kitsap Counties?
What program location do you prefer?
Should be Empty: