First Name *

Last Name *

Age *

Are you a CURRENT member of the Nishna Valley Family YMCA? *

Email *

Would you like to OPT in and receive weekly encouragement messages/ videos via EMAIL? *

Phone Number *

Would you like to OPT in and receive weekly encouragement messages/ videos via TEXT? *

T-Shirt Size (Adult) *

Are you participating in this challenge with a business, family, or friends? *