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YMCA of Greater Charlotte
YMCA of Greater Charlotte
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WEIGHT LOSS PROGRAM

INQUIRY FORM

We are committed to reaching all groups, irrespective of gender, location, education, or race/ethnicity. The information you provide will help to ensure we are reaching all members of the community. We therefore request that you answer all the following questions.

As a leading nonprofit improving the nation’s health, the Y supports all individuals in achieving their health goals. The Y is always striving to learn more about program improvement, to that end, we are requesting your permission to collect your participation data:

Day of the Week Preference:






Time of the Day Preference:

Interested in adding Small Group Training to Weight Loss Program?:
Additional Cost: $30
I acknowledge the transfer of data from the local YMCA into the secure database supported by YMCA of the USA for purposes of evaluating and improving the Weight Loss program.:
I authorize and acknowledge that I have read, understand and agree to the above.:


Thank you for filling out the inquiry form for the YMCA Weight Loss Program. Our program specialist will be in contact with you via email within 2 business days of submitting this form to provide additional information and to register you in the program.