Y-Weight - Weight Loss Challenge

Y-Weight Weight Loss Program Application

Thanks for your interest in the YMCA's weight loss challenge - Y Weight. This is an intensive program for those looking to make a lifestyle change. This involves regular exercise, nutritional counselling and weekly weigh-in's. Please note that a limited number of applicants will be chosen for this Session. YMCA Members receive a discounted rate for this program. Please contact the YMCA Membership Services desk for details.

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* 1. Name

Last, First

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* 2. Session Date (see Program Guide)

Date

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* 3. Phone Number

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* 4. Email address

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* 5. About you

Age

Height (INCHES)

Weight (LBS)

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* 1. Name

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* 2. Session Date (see Program Guide)

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* 3. Phone Number

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* 4. Email address

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* 5. About you

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* 6. Tell us your story. Why would you like to be selected to participate in the YMCA of Kingston's Y Weight Challenge?