Enhance Fitness Interest Form
*Please note this is to share your interest in the program, it does not mean you are enrolled*
Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Phone Number
-
Area Code
Phone Number
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
County
*
Have you been diagnosed with arthritis?
Yes, self-diagnosed
Yes, diagnosed by a medical professional
No
Have you been cleared by a medical professional to engage in physical activity?
Yes
No
How did you hear of Enhance Fitness?
Self (decided to on own)
Non-primary car health professional
Primary Care Provider/Office
Community-based organization/Community Healthcare Worker
YMCA Staff
Family or Friend
Employer or employer's wellness program
Insurance Company
Media (new, advertising or social media)
Kitsap Area Agency on Aging
Pierce County Human Services
Are you a current member of the YMCA of Pierce and Kitsap Counties?
Yes
No
What program location do you prefer?
Haselwood Family YMCA - Silverdale
Tom Taylor YMCA - Gig Harbor
Tacoma Center YMCA - Downtown Tacoma
Morgan Family YMCA - Pearl Street
Lakewood Family YMCA - Lakewood
Virtual - online via ZOOM
Submit
Should be Empty: