Workplace Wellness with the Y

Workplace Wellness with the Y

Please fill this form out so that I have a better understanding of your needs.
Name of Business*
Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Business Website *
Number of Employees*
Number of Locations*
Which branch is your business near?*

Anthony Wayne YMCA - Waterville, OHEastern Community YMCA - Oregon, OHFort Meigs YMCA - Perrysburg, OHFrancis Family YMCA - Temperance, MIFrank & Shirley Dick Family YMCA - Adrian, MISylvania YMCA/JCC - Sylvania, OHWayman D. Palmer YMCA - Toledo, OH (Bancroft & Cherry)West Toledo YMCA - Toledo YMCA (Tremainsville Rd)Wolf Creek YMCA - Maumee, OH
Do you currently have a Wellness Program in place for your employees?*

YesNo
CONTACT INFORMATION
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Job Title*
Are you responsible for making the final decision on a Wellness Program?*

YesNo
HELP US BETTER UNDERSTAND WHAT YOU ARE LOOKING FOR
What are you looking to provide to your employees?*

Discount on a Gym MembershipDiscount on Child CareEducational Lunch & LearnsOther
How soon are you looking to incorporate a Wellness Program?*

As soon as possibleNext 3 MonthsNext 6 MonthsOther
Should be Empty:

CONTACT INFORMATION