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YMCA OF WESTERN NORTH CAROLINA
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User account menu
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Main navigation
Home
Virtual YMCA
Programs
Health & Fitness
Find a Program
Active Older Adults
Sports
Coaching Connection
Community Health
Group Exercise Classes
Group Training
Personal Training
Weight Loss Program
Westridge CF
Schedules
Children & Teens
Childcare
Center Childcare
Middle School Programs
Teen Programs
Sign Up
Swimming
Aquatics Specialty Training
Drowning Prevention
Swim Lessons
Lifeguard Certification
Buncombe County Schools Aquatics Center
Patton Pool
Piranhas Swim Team
Find a Class
Camps
Overnight Camp
Summer Day Camps
School's Out Camps
Half-Day Camps
Find a Day Camp
Community
Nutrition Outreach
Diabetes Programs
Falls Prevention
Financial Assistance
LIVESTRONG at the YMCA
Diversity and Inclusion
Volunteer
Schedules
Locations
About
Reopening Guide
About the Y
GIVE
Impact
News
Events
Careers
Contact
Membership
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Community Health Interest Form
This form does not register you for any Y program. You will be contacted by a member of the Community Health team (by phone, then email) after you complete this form. Thank you!
First Name
Middle Name
Last Name
Date of Birth
You can maually enter your DOB or use the calendar icon.
Phone
Email
Primary Language (How can we better serve you?)
Primary Language (How can we better serve you?)
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English
Spanish
Other…
Enter other…
Are you a Y member?
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Yes
No
What class are you interested in?
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Taking Control of Type 2
Diabetes Prevention Program at the Y
LiveSTRONG at the Y
EnhanceFitness
Moving for Better Balance
How did you hear about our programs?
How did you hear about our programs?
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Doctor
Employer
YMCA Website
YMCA Social Media
YMCA Staff Member
Other…
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What time do you need class?
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Morning
Afternoon
No Preference
At which YMCA location would you be interested in attending class? (Check all that apply)
Asheville YMCA
Black Mountain YMCA
Corpening Memorial YMCA
Ferguson Family YMCA
Hendersonville Family YMCA/Kellogg Center
Reuter Family YMCA
Woodfin YMCA
YMCA at Mission Pardee Health Campus
Other…
Enter other…
Would you prefer if the class was virtual?
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Yes
No
Additional Comments