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
City
State / Province
Postal / Zip Code
Business Website
*
Number of Employees
*
Number of Locations
*
Which branch is your business near?
*
Anthony Wayne YMCA - Waterville, OH
Eastern Community YMCA - Oregon, OH
Fort Meigs YMCA - Perrysburg, OH
Francis Family YMCA - Temperance, MI
Frank & Shirley Dick Family YMCA - Adrian, MI
Sylvania YMCA/JCC - Sylvania, OH
Wayman 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?
*
Yes
No
CONTACT INFORMATION
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Job Title
*
Are you responsible for making the final decision on a Wellness Program?
*
Yes
No
HELP US BETTER UNDERSTAND WHAT YOU ARE LOOKING FOR
What are you looking to provide to your employees?
*
Discount on a Gym Membership
Discount on Child Care
Educational Lunch & Learns
Other
How soon are you looking to incorporate a Wellness Program?
*
As soon as possible
Next 3 Months
Next 6 Months
Other
Submit
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